Legal aspects and other

Question 1

IMCA role

Answer 1

Independent mental capacity assessor

• Involved in ‘best interest’ decisions

Question 2

DOLS

Answer 2

Deprivation of liberty safeguard
Completed if decision is made that impacts their ability to leave, or if they are controlled or supervised in any way in which they cannot consent to.

Question 3

Power of attorney
1. When is this applied for
2. What power do they get

Answer 3

1. When patient has capacity
2. Health and welfare
   and Property and financial affairs

Question 4

When is court of protection used

Answer 4

1. When LPA is not making decisions in the pts best interest
2. All capacity decisions related to contraceptive sterilisation, organ donation and withdrawal of nutrition and hydration in permanent vegetative state

Question 5

When should capacity be assessed

Answer 5

Assess for every decision as mental state can fluctuate, and may have capacity to make certain decisions e.g. what to wear/eat but not enough capacity to make bigger decisions

Question 6

What must a pt demonstrate to have capacity

Answer 6

1. Understand information
2. Retain information
3. Use the information to make a decision, including weighing up risks and benefits
4. Communicate their decision

Their decision does not need to seem wise to you, as long as they can support their flawed logic with their own reasoning.

Question 7

What to do if pt lacks capacity?

Answer 7

1. Find least restrictive option
2. Make decisions in patients best interest
3. Fill in documentation for mental capacity act to protect pts rights

Question 8

Advanced decision to refuse treatment (ADRT)

Answer 8

Written and signed document that details specific scenarios in which a pt wants to refuse specific treatment.
e.g. I refuse to have dialysis in the event my kidneys fail

Question 9

When can you act against the wishes of a pt with capacity

Answer 9

If there is an immediate threat to life, senior clinician must be involved.

Question 10

DNAR - who makes the decision

Answer 10

Doctor makes decision to offer CPR or not (DNAR).
The patient cannot decide to have CPR, but can refuse CPR in advance

Question 11

Ethical issue with DNAR

Answer 11

Patient autonomy vs Beneficence
* Autonomy - patients right to make decisions
* Beneficence - The potential for doctors to provide life sustaining treatment

Question 12

Advanced care plan

Answer 12

Patient can discuss and make a plan for their care in advanced whilst they have capacity. This is not a legal document, but can be used to understand the pts wishes

Question 13

What is carer strain and its effect

Answer 13

The consequences caring for an individual has on somebody.
1. 75% have mental health effects
2. 60% have worse physical health

Question 14

Components of comprehensive geriatric assessment (CGA)

Answer 14

1. Medical
2. Functional
3. Psychological
4. Social
5. Environmental

Question 15

CGA Medical components

Answer 15

• Problem list
• Co-morbidities
• Medications
• Nutrition

Question 16

CGA functional components

Answer 16

• Basic ADLs
• Gait and balance
• Exercises and activity

Question 17

CGA - psychological components

Answer 17

• Cognitive status
• Mood assessment

Question 18

CGA social and environmental components

Answer 18

• Support network
• Housing
• Finances
• Access to transport
• Safety at home

Question 19

Clinical frailty scale

Answer 19

1. Very fit
2. Well
3. Managing well (well controlled medical problems but not very active)
4. Vulnerable (not dependent but symptoms limit activities e.g. tired during the day)
5. Mildly frail (need help with high order ADLs e.g. finances, transport, medications)
6. Moderately frail (help with all outside activities and may need help with bathing)
7. Severely frail (completely dependent personal care, high risk of dying within 6 months)
8. Very severely frail (completely dependent, approaching end of life, won’t recover from minor illness)
9. Terminally ill (not evidently frail, but approaching end of life within 6 months