ETHICO-LEGAL
CONSIDERATIONS/ETHICAL
PRINCIPLES & MEDICATIONS
IN THE CARE OF OLDER
ADULTS
Prepered by: Caroline V. San Diego MAN,RN
At the end of the course unit (CU), 1
learners will be able to:
Cognitive:
[Link] awareness regarding the
Senior Citizen Law in the Philippines.
2. List measure to promote safe drug
use..
3. Identify proper uses and risks using
common drug used with elderly.
ETHICS OF CARE 2
1. ADVOCACY
2. AUTONOMY
3. BENEFICENCE / NONMALEFICENCE
4. CONFIDENTIALITY
5. FIDELITY
6. FIDUCIARY RESPONSIBILITY
7. JUSTICE
8. QUALITY AND SANCTITY OF LIFE
9. RECIPROCITY
10. VERACITY
ISSUES TO BE CONSIDERED 3
Issues on Conflict of
interest
1. Actual Conflict of
Interest issues-
between family
members and
caregivers represent
the elderly or assist
them in decision-
making
Issues on Conflict of Interest 4
These include conflicts:
Between spouses and the
elder’s wishes and interest;
Between family members and
the elder’s wishes and
interest;
Between a guardian,
conservator or other lawfully
designated agent and the
elder’s wishes and interests;
Between a caregiver’s
business interests and the
elder’s interests. Well-being
and quality of life.
Issues on Conflict of Interest 5
2. Perceived Conflicts of
Interest – which
include those which
are not actual conflicts
in the course of care
but may later become
conflicts when the
elder patient’s interest
diverge from those
who provide the care.
Issues on Confidentiality 6
in caring for an
elderly patient,
invariably, there is
disclosure made by the
family and relatives
regarding information
that may otherwise be
personal and
confidentiality to the
patient alone.
Issues on Decision- Making Capacity 7
Many times, the older
patient’s decision-
making capacity ( also
referred to as “
competence”) may be
required for certain
decisions.
Legal Risks in Gerontological Nursing
Malpractice
Confidentiality
Patient consent
Patient competency
Staff supervision
Medications
Restraints
Telephone orders
Do not resuscitate orders
Advance directives and issues related to death and dying
Elder abuse
Benefits and Previleges of
17
“Senior Citizen”
RA 7432 – known as “an act to maximize the
contribution of senior citizens to nation building,
grant benefits and special privileges and for other
purposes”.
Republic Act No. 8425 – provides for the
institutionalization and enhancement of the social
reform agenda by creating the National Anti-
Poverty commission (NAPC).
Benefits and Previleges of
18
“Senior Citizen”
Republic act No. 344 or the Accessibility Law of
1982 – provides for the minimum requirements and
standards to make buildings, facilities, and utilities
for public use accessible to persons with disability,
including older persons who are confined to
wheelchair and those who have difficulty in walking
or climbing stairs, among others.
Benefits and Previleges of 19
“Senior Citizen”
Republic Act No. 9994. “Expanded Seniors Citizen
Act of 2010”- an act granting additional benefits
and privileges to senior citizens, further amending
Republic Act No. 7432 and otherwise known as “an
act to maximize the contribution of senior citizens to
nation building, grant benefits and special
privileges and for other purposes.
Benefits and Previleges of
20
“Senior Citizen”
Republic Act No. 10155, “ The General
Appropriations Act of 2012” – under Section 28
mandates that all government agencies and
instrumentalities should allocate one percent of their
total agency budget to programs and projects for
older persons and persons with disability
Benefits and Previleges of
21
“Senior Citizen”
Republic Act No. 10645, An Act Providing For the
Mandatory Philhealth Coverage for All Senior
Citizens”, Amending for the purpose, Republic act
No. 7432, as amended by Republic Act No. 9994
by removing the qualification that a senior citizen
has to be indigent before being covered by
PhilHealth
Benefits and Previleges of
22
“Senior Citizen”
Republic Act No. 10868, “Centenarians Act of
2016”, An Act Honoring and Granting Additional
Benefits and Privileges to a FILIPINO
CENTENARIANS. All Filipinos who have turned
centenarian in the current fiscal year shall be
awarded a plaque of recognition and a cash
incentive by their respective city or municipal
governments in appropriate ceremonies in addition
to the LETTER of FELICITATION and centenarian gift
of P 100,000.00.
Benefits and Previleges of
23
“Senior Citizen”
Presidential Proclamation No. 470, Series of
1994, declares the first week of OCTOCER of
every year as “ Elderly Filipino Week.”
Presidential Proclamation No. 1048, Series of
1999,declaring a “Nationwide Observance in the
Philippines of the International Year of Older
Persons”.
Benefits and Previleges of
24
“Senior Citizen”
Executive Order No. 105, series of 2003, approved
and directed the implementation of the program
providing for group homes and foster homes for
neglected, abandoned, abused, detached, and poor
older persons and persons with disabilities.
The Philippine Plan of Action for senior Citizens
(2011-2016). This plan aims to ensure giving priority to
community-based approaches which are gender-
responsive, with effective leadership and meaningful
participation of senior citizens in decision-making
processes, both in the context of family and community.
PHARMACOLOGY AND
OLDER ADULTS
Older persons body is at
greater risk for adverse
drug events than younger
persons.
In body water ( as much as 15%)
•results to increase concentration
of water-soluble drugs ( e. g.
alcohol)
in body fat
•more prolonged effects of fat-
soluble drugs
hepatic blood flow
results in increased toxicity= Increased SGPT
Increased PT,
PTT
serum albumin level
•altered binding capacity
•increased serum level of the free or unbound
proportion of protein- bound drugs
•toxic level of highly bound drugs
PREDICTORS OF MEDICATION RESPONSE
GENERAL STATE OF HEALTH
NUMBER AND TYPES OF OTHER
MEDICATIONS TAKEN
LIVER (sgpt) , RENAL FUNCTION -
Creatinine
PRESENCE OF COMORBIDITIES OR
OTHER DIAGNOSED DISEASES
MEDICATION ERROR
Results from human
knowledge based deficiencies
and a lack of sophisticated
systems to support and
monitoring drug therapy.
2 IMPORTANT DISTINCTIONS IN
MEDICATION ERROR LANGUAGE
ADVERSE DRUG REACTION ( ADR)
• any unintended response to a drug that occurs
when drugs are used to diagnose, treat or prevent
disease.
• ADR INCLUDES:
Difficulties in the activity of daily living.
Cognitive changes
Falls
Anorexia, nausea
Weight changes
ADVERSE DRUG EVENT (ADE)
any injury that results when
medications are used, and this includes
both ADR’s and medication errors that
lead to an ADR.
NOTE: the use of too many or wrong
types of medications increases the risk
of both an ADE and non-adherence!!!!!
FACTORS THAT CONTRIBUTE TO
INCREASED RISK OF ADE
1. PHARMACOKINETIC CHANGES : WHAT
THE BODY DOES TO THE DRUG???
DRUG ABSORPTION
Do not usually contribute to drug
response and have less impact on
pharmacokinetics.
altered distribution into the peripheral
circulation and tissues
decrease in plasma albumin levels with
age may result in decreased binding of
drugs that are mainly bound to serum
albumin
decrease in total body water, and
intracellular water volumes may lead to an
increased serum concentration of water
soluble drugs such as lithium and alcohol
DRUG DISTRIBUTION
increase in body fat may increase in the
distribution of fat- soluble medications ( e. g.
benzodiazepines) into fatty tissue, resulting in
prolonged half-lives and drug accumulation
HEPATIC METABOLISM
age-related metabolism is not easily
measured.
Primarily, biotransformation occurs in
liver, where enzymatic activity alters and
detoxifies the drug to prepare it for
excretion.
RENAL EXCRETION
the most important pharmacokinetic
parameter that changes with age
changes is extremely variable, majority of
older adults have a decline kidney function,
requiring a decrease dose or extension of
interval for certain drugs
SERUM CREATININE may be used as indirect
estimate of renal function.
CREATINE CLEARANCE is an estimate of GFR
and decreases with age.
2. PHARMACODYNAMIC CHANGES
WHAT THE DRUG DOES TO THE BODY??
Aging may result in different
responses for older adults to the
same drug concentrations at the
site of action compared with
younger adults.
CHANGES IN PHARMACODYNAMICS IN
OLDER PERSON MAY BE CAUSED BY:
Altered number of receptors or
affinity.
Decreases in receptor binding.
Altered cellular response to the drug
receptor- receptor interaction.
Organ pathologic condition.
Altered homeostatic mechanism.
3. DRUG-DRUG INTERACTION
an interaction between one drug and another
can result from altered pharmacokinetics or
pharmacodynamics.
it is largely thought that alterations in hepatic
metabolism are specifically responsible for
drug-drug interaction.
EX: Warfarin and aspirin- increased risk for
bleeding.
4. DRUG-FOOD INTERACTION
the effect of a drug or food can be
influenced by their combined actions.
EX: Theophylline and caffeine-
increased risk for potential toxicity.
Levodopa and clonidine-
decreased antiparkinsonian effect.
5. DRUG- DISEASE INTERACTIONS
certain states may be
exacerbated by specific drug
therapies, and these drugs may
be contraindicated in patients with
coexisting underlying disease.
EX: Aspirin, NSAID’s and Atrophic
gastritis- GI hemorrhage
POLYPHARMACY
Prescription, administration, or use of more
medications that are clinically indicated in given
patient.
MULTIPLE MEDICATIONS INCREASE THE CHANCE
OF:
1. drug-drug interaction
2. ADE’s and ADR’s
3. Error of dosing
PREVENTION OF POLYPHARMACY
1. Use of the same pharmacy to fill all
prescriptions.
2. Notification to all prescribing
clinicians of drug used.
3. Nurse obtaining a complete history
of all drugs used.