Nursing Seminar Presentation

1. Legal & ethical issues
provisions and
programmes for elderly

2. - The most common legal and ethical issues in
geriatric care involve assessment of decision
capacity and competence, identification of decision
makers, resolution of conflicts about the disclosure
of information, termination of treatment at the end
of life, and decision about long-term care. The
programmes and schemes are meant to promote the
health, well-being and independence of elderly
people around the country

3.  Legal guidance and assistance is needed by many
older adults. Legal issues include advance directives,
estate planning, taxation issues, appeals for denied
services (eg., disability), financial decisions, or
exploitation by strangers or “trusted others”. In
India the maintenance and welfare of parents and
senior citizens act, 2007, is one of the ways that
provide legal assistance for older adults.
 Advanced directives are written statements of a
person’s wishes regarding medical care. A health
care proxy may be appointed to make medical
decisions in the event that a person is unable to
make his or her own medical decisions.

4.  When working with older adults, you may find
several ethical issues that influence practice, such
as the assessment of older adults ability to make
decision. Other ethical issues related to end-of-life
care include decisions about resuscitation,
treatment of infections, nutrition and hydration,
and transfer to more intensive treatment unit.

5. These situations are often complex, especially during
emotionally difficult times. You can assist the older
adult, family, and other health care workers by:
1) Keeping current on the ethical issues
2) Acknowledging when an ethical dilemma is present
and
3) Advocating for an institutional ethics committee to
help provide guidance in the decision-making process
and assist when differences of opinion occur.

6.  physical abuse: slapping, striking, restraining,
incorrect positioning, oversedation with medications
 Neglect: failure or refusal to provide basic life
needs, including food, water, medication, clothing,
hygiene. Failure to provide physical aids such as
dentures, eyeglasses, hearing aid. Failure to ensure
safety
 Psychological abuse: berating verbally, harassment,
intimidation, threats of punishment, or deprivation.
Childlike treatment, isolation.
 Sexual abuse: nonconsensual sexual contact,
including touching inappropriately. Forced sexual
contact.

7.  Financial abuse: denying access to personal
resources, stealing money or possessions. Coercing
to sign contracts or durable power or attorney.
 Violation of personal rights: denying right to privacy
or right to make decisions regarding health care or
living environment. Forcible eviction.
 Abandonment: desertion of an older person by an
individual who has assumed responsibility for
providing care or by a person with physical custody.

9.  Due to urbanisation , industrialisation & impact of
western culture, the elderly people are neglected by
the children. Due to which aged suffer from
numerous familial, social, economic and psychological
problems. This has led to the need of welfare
services for oldage people
 The welfare services provided for old age people are
a) pension: pension scheme for the people who retire
from government service. The pension is provided as
per fixed formula. Along with pension, other
facilities such as medical allowance reimbursement
and benefits of encashment of earned leave. Pension
Rs.300/- per month. This amount is meagre.

10. B) Medical care at concessional rate: the schemes are there
in government & private organisations where medical
services to old age people are provided at concessional
rate.
c) Old age homes: The government of india under welfare
scheme for old age has established old age homes to
provide residential facilities & other needs such as
recreational needs. The old age people are entertained
here by physical & mental activity and by creativity to
combat loneliness.
d) Voluntary organisations: The voluntary organisations and
associations are concerned with the welfare of aged.
These are:
- Help age India
- Age care India

11. 1)Help age India: Help age India is a voluntary
organisation with its head office in new delhi. It has
22 centres in major cities. The activities of help
age India are:
- creating awarness about the n eeds of aged in
society.
-Conducts various events such as debates, painting etc.,
-Training to individuals who are engaged in old
programmes.
-Manages mobile medicare unit

12. 2) Age care india: age care india is a voluntary
organisation to provide services to aged males &
females above 50 years through:
-domicillary, residential & institutional services.
-educational, recreational, social, cultural & spiritual
services.
-Medical services
-Part time employment.
-Tours, trips for old age.
-Professional consultancy services for taxes, duties,
pension etc.,

13. - Research & studies on old age problems.
- Creation of understanding and providing
suitable environment for old age.
Age care India has four types of members:
a)Founder members
b)Life members
c)Associate members
d)Temporary members

14. - The age care India for the welfare of aged
people was established on 18th november, 1980
and since 1981, elder’s day is celebrated on 18th
november every year.
e) Other benefits for old age:
-Railway travelling concession.
-Preference in hospitals for medical services. In
other words, separate sections or counters for
registration in O.P.D and preference to old age
for providing services

15. - National policy on older persons.
- Ministry of rural development.
- Ministry of finance.
- Ministry of health and family welfare
- Ministry of railways
- Ministry of civil aviation
- Ministry of road transport and highways.
- Department of post office.

16. - Administrative set up:
a) Ministry of social justice & empowerment.
b) Nodal ministry which focuses on policies &
programmes for the senior citizens in close
collaboration with state governments, NGOs
and civil society.

17. - Article 41 of the constitution provides that the
state shall, within the limits of its economic
capacity and development, make effective
provision for securing the right to work, to
education and to public assistance in cases of
unemployment, old age, sickness &
disablement & in other cases of undeserved
want

18. # Maintenance and welfare of parents and senior
citizens act, 2007:
The act provides for:
- Revocation of transfer of property by senior
citizens in case of negligence by relatives
- Penal provision for abandonment of senior
citizens
- Establishments of old age homes
- Adequate medical facilities and security for
senior citizens

19.  Announced in january 1999 to reaffirm the
commitment to ensure the well-being of the
older persons
 Envisages state support to ensure
- Financial and food security
- Health care,
- Shelter,
- Equitable share in development,
- Protection against abuse and exploitation,

20. - Constituted in 1999
- Under the chairpersonship of the minister for
social justice empowerment to oversee
implementation of the policy

21. - Comprises of twenty-two
ministries/departments
- Headed by the secretary, ministry of social
justice & empowerment
- Considers action plan on ageing issues for
implementation by various
ministries/departments concerned, from time
to time

22.  Implemented since 1992
 Objective of improving the quality of life of
senior citizens by providing basic amenities
like
- Shelter
- Food
- Medical care
- Entertainment opportunities

24.  Title:Ethical Issues Related to Research Involving Elderly Subjects
 Warren T. Reich, STD 18-19July 2007
 There are five areas in which significant eth- ical issues are raised by research with
the aged. Whether taken singly or especially when re- garded cumulatively, these
ethical problems seem to require some special protections, in the form of federal
regulations or guidelines, institutional regulations, and/or professional standards
and codes.
 Certainly some well designed, interdisci- plinary studies, focusing on the ethical
issues, are essential. This article is intended as a partial agenda for a sustained
investigation in this area. The investigation should make inquiry into: (1) the
definition of the aged for purposes of clar- ifying the situation with respect to
research in- volving them; (2) the nature and extent of bio- medical and behavioral
research involving the aged together with criteria used for their se- lection; (3) the
current state of knowledge on physiological and psychological conditions in the
aged that may make them vulnerable in the various ways suggested in this article;
(4) the conditions under which research in the aged is conducted, especially in
institutions — homes for the aged, nursing homes, geriatric wards, and mental
hospitals — including a profile of the relevant institutional factors especially those
posing a risk for impairing freedom; (5) the question of consent and how it is
obtained, as well as the differences of consent obtained with or without the
assistance of advocates;

25.  (6) the goals, purposes, and priorities of research in- volving the aged, the risks and benefits
com- monly expected, and the principles for assess- ing them; and (7) the possible grounds for
promoting research in conformity with present and developing regulations, or for regulating
such research according to reasonable, ethical standards.
 Summary
 Noting a general neglect of studies on ethical aspects of biomedical and behavioral research
involving elderly subjects, this article first explains three ethical principles that are par-
ticularly applicable to human research — the principles of beneficence, Just distribution, and
respect for persons — and the four ethical issues in human research that have a special bearing
on research in the aged: (1) the goals and purposes of research: its moral justifica- tion; (2) risk-
benefit analysis; (3) selection of subjects; and (4) informed consent.
 Second, within a methodological framework characterized by these principles and issues,
together with associated ethical rules, the article identifies five aspects of research in the
elderly that raise distinctive ethical problems: (1) anti-aging research; (2) health problems in
the aged that make them vulnerable to exces- sive selection for reseach; (3) conditions of the
elderly that create problems of competence and free consent to research; (4) surrogate consent
and the problem of guardianship; and (5) special problems in competence and free consent for
the institutional izecJ elderly.

26.  Scientific studies and sources from various disciplines are cited to clarify
the problems, to arrive at ethical conclusions, and to make tentative
proposals concerning policies needed for the protection of elderly
research subjects. The policy proposals include recommendations
regarding clarification of the objectives and priorities of research such as
anti-aging studies; a just distribution of research burdens and benefits
among the aged according to stated factors; inclusion in the review
process of the perspective of elderly persons not committed to the
research; assessment of the competence of the elderly in some
circumstances; use of a patient advocate to assist in assessing compe-
tence and freedom of potential elderly subjects; facilitation of legal
designation of personal guardian by the subject prior to mental decline
and incompetence; restriction on use of in- stitutionalized elderly
subjects; and accredi- tation of institutions for the elderly where re- search
would be conducted.
 Third, the article proposes an agenda for a sustained interdisciplinary
study of the ethical and policy dimensions of research with aged subjects.

27.  http://WWW.senior indian.com/OASIS_htm
 http://WWW/tn.gov.in/schemes/swnmp/social
security-net.pdf
 http://www/helpage india.org/aboutus.php
 ICMR. Health care of the elderly. Bulletin
1996;26(5)
 Voluntary association of health india. Health
problems of specialized groups. Chapter 14, 1997
 Textbook of lewis’s medical surgical nursing-II,3rd
south asian edition pg no:55-61