consent for geriatric fracures

1. Informed consent for geriatric hip fractures
Dr Uday Kumar
MS(Orth) DNB(Orth)
Sagar Hospitals
Sindhi Hospital
Chinmaya Hospital
Bangalore
6th Sept 2015
ASRAM MC
ELURU

2. 75 year old lady---fracture neck femur
Treatment?

3. 80 year old male ----trochanteric fracture
Treatment?

4. What is “Consent?”
Defined as permission,
approval, or assent

5. Consent given by the patient
based on knowledge of the procedure
to be performed,
including its risks and benefits,
as well as alternatives to the proposed
treatment.
What is “INFORMED Consent”?

6. -- is no longer an option.
It is now a must under the
current guidelines &
regulations
INFORMED Consent

7. Informed consent
is it
a Document or a Process ??

8. Consent is a continuous process,
not a one-time event
 pre op
Intra op
Post op

9. Elderly patients
Co-morbid conditions
Hypertension
Diabetes
IHD
COPD
Osteoporosis

10. Elderly patients are particularly vulnerable in the
informed consent process.
• Medical conditions: Impairs cognition
e.g.hearing loss, vision loss
• Social Factors: physical dependency,
financial impoverishment,
restricted health care resources
and family pressures

12. The Consent process:
Information
provided
Information
understood
Decision
made
Comprehension
monitored and
maintained

13. Voluntariness
Disclosure
Competence Understanding
REQUIREMENTS

14. The Process of Consent:
• Choose the right environment and location
• Involve multiple health care personnel –
surgeon, physician, anesthetist, cardiologist etc
• Include all family members in the process

15. Consent Process Plan
Decide where consent discussion will be held
• Conduct it in a quiet area
• Patient and attenders
should have adequate
uninterrupted time
Provide space for family members or friends to
be present during the consent discussion

16. Consent Process Plan
Provide adequate time to explain the surgery
procedure to the attenders
• Draw a visual description of the procedure
• Use patient education tools / brochures to
assist in discussion
• Explain the responsibilities of the attenders—
get them over to your side

17. Consent Process Plan
Provide adequate time for patient/attenders to read
and consider
- No undue influence or coercion
- Allow them to discuss with families or friends
Provide time for questions to be answered about
morbidity and mortality and alternative treatments

18. Summary for Consent for surgery
Benefits
Contact
Purpose Risks
Alternative Confidentiality Costs
Voluntary

19. DatePatient or
Legally Acceptable
Representative
Surgeon Date
DateWitness
Who can sign the Consent Form?
Impartial Witness

20. A good consent form:
 Complete information
 Accurate information
 In compliance with regulations and
guidelines
 Short simple sentences
 Simple understandable language
 Culturally sensitive language

21. Common Findings:
 Too long consent form
 Too complicated language
 Not all the complications are mentioned
 Alternative treatments not given

22. Common Findings:
• Surgical procedures are not accurately described
• Benefits of the operation are over-stated
• Risks are not completely mentioned

23. Challenges regarding informed
consent
Two main challenges in our
country:
•Illiteracy
•Culture,traditions and religion

24. Honesty
builds
Trust

25. Take home message
Take a proper informed consent
Get the attenders to your side
Explain all the pros and cons of the surgery planned
Inform the progress of the patient pre, intra and post op
Do not perform heroic surgery on the elderly