Posters

Presenting Author

Jessica Flores

Presentation Type

Poster

Discipline Track

Patient Care

Abstract Type

Case Report

Abstract

According to the Census Bureau, the United States will have more than 20% of its population above age 65 by 2030, bringing ethical dilemmas in balancing risk and autonomy in geriatric patients to the forefront. Many geriatric persons rely on social support to fulfill their safety and autonomy needs, but those who lack a network are faced with increased challenges.

An 80-year-old male with a history of multiple comorbidities presents to the UTRGV-DHR internal medicine outpatient clinic. His medical history includes coronary artery disease, heart failure, atrial fibrillation, chronic kidney disease, basal cell carcinoma of the nose, gout, tobacco abuse and vision impairment. This patient presented for follow up and denied any medical complaints but reported difficulties with tasks of daily living. Due to his vision impairment, he cannot see his food or read his medication labels. However, he still drives himself to appointments. The patient has no social support except for home health services through Medicare that fill pillboxes with his daily medications. During his visit the patient mentioned he had not had a home health visit recently; he was concerned that he might make a mistake taking the medications on his own. The patient insists that living in a nursing home or anything similar would be “worse than being in jail.” He has competency and capacity to make his own decisions and therefore his physicians pursued options to support him at home.

This case demonstrates the importance of respecting desired autonomy while simultaneously working to preserve safety and mitigate risk. Providers must balance autonomy with safety including in geriatric patients. All choices in life involve risk. Discussion of patient’s desired risk tolerance in order to preserve which aspects of freedom is key to meaningful shared decision making in the elderly.

Academic/Professional Position

Medical Student

Mentor/PI Department

Internal Medicine

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Balancing Autonomy and Safety in the Care of a Senior Patient: To Place or Not to Place?

According to the Census Bureau, the United States will have more than 20% of its population above age 65 by 2030, bringing ethical dilemmas in balancing risk and autonomy in geriatric patients to the forefront. Many geriatric persons rely on social support to fulfill their safety and autonomy needs, but those who lack a network are faced with increased challenges.

An 80-year-old male with a history of multiple comorbidities presents to the UTRGV-DHR internal medicine outpatient clinic. His medical history includes coronary artery disease, heart failure, atrial fibrillation, chronic kidney disease, basal cell carcinoma of the nose, gout, tobacco abuse and vision impairment. This patient presented for follow up and denied any medical complaints but reported difficulties with tasks of daily living. Due to his vision impairment, he cannot see his food or read his medication labels. However, he still drives himself to appointments. The patient has no social support except for home health services through Medicare that fill pillboxes with his daily medications. During his visit the patient mentioned he had not had a home health visit recently; he was concerned that he might make a mistake taking the medications on his own. The patient insists that living in a nursing home or anything similar would be “worse than being in jail.” He has competency and capacity to make his own decisions and therefore his physicians pursued options to support him at home.

This case demonstrates the importance of respecting desired autonomy while simultaneously working to preserve safety and mitigate risk. Providers must balance autonomy with safety including in geriatric patients. All choices in life involve risk. Discussion of patient’s desired risk tolerance in order to preserve which aspects of freedom is key to meaningful shared decision making in the elderly.

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