Informed consent for geriatric hip fractures

Dr Uday Kumar MS(Orth) DNB(Orth)Sagar HospitalsSindhi HospitalChinmaya Hospital Bangalore

6th Sept 2015 ASRAM MC ELURU

75 year old lady---fracture neck femur

Treatment?

80 year old male ----trochanteric fracture

Treatment?

What is “Consent?”

Defined as permission, approval, or assent

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”?

-- is no longer an option.

It is now a must under the current

guidelines & regulations

INFORMED Consent

Informed consent is it

a Document or a Process ??

Consent is a continuous process, not a one-time event

pre op Intra opPost op

Elderly patients

Co-morbid conditions

HypertensionDiabetesIHDCOPDOsteoporosis

Elderly patients are particularly vulnerable in theinformed 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

The Consent process:

Information provided

Information understood

Decision made

Comprehension

monitored and

maintained

VoluntarinessDisclosure

Competence Understanding

REQUIREMENTS

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

Consent Process PlanDecide 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

Consent Process PlanProvide 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

Consent Process PlanProvide 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 aboutmorbidity and mortality and alternative treatments

Summary for Consent for surgery

Benefits

Contact

Purpose Risks

Alternative Confidentiality Costs

Voluntary

DatePatient orLegally Acceptable Representative

Surgeon Date

DateWitness

Who can sign the Consent Form?

Impartial Witness

A good consent form: Complete information Accurate information In compliance with regulations

and guidelines Short simple sentences Simple understandable

language Culturally sensitive language

Common Findings: Too long consent form Too complicated language Not all the complications are

mentioned Alternative treatments not given

Common Findings: • Surgical procedures are not accurately

described

• Benefits of the operation are over-stated

• Risks are not completely mentioned

Challenges regarding informed consent

Two main challenges in our country:• Illiteracy

•Culture,traditions and religion

Honesty

buildsTrust

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

Respect your elders if

you want to get respected.

Thanks