The ethical primacy of patient involvement in treatment decision-making requires that more attention be paid to assessment of a patient's competency to make treatment decisions. Makes recommendations to increase sensitivity to this issue with significantly impaired elderly nursing home patients and to improve existing decision-making procedures.…

The elderly patient's choice to die may only appear to be independent of the family's choices. Behind patient's choice often lie implicit interpersonal and overt personal reasons. These must be understood to provide optimal care for patient and family. Case examples of undeliberate and deliberate clarification are offered. (Author)

Presents model for interdisciplinary discharge planning team, with emphasis on functional status and improved coordination and continuity among providers. Describes design and implementation of such a program at university hospital. Explains how model resulted in more patients being discussed and served, with more emphasis on the functional…

Shared decision making about placement and medical interventions can be empowering to older persons, relieve burdens on older person and family, and facilitate better surrogate decision making later. Potential dangers of shared process include coercion, conflicts of interest, and disagreements between family members. New legal concepts could help…

Describes assessment technique used by interdisciplinary staff on coed Alzheimer's disease unit to help determine patients' competencies to participate in intimate relationships. Two case studies are presented to highlight how assessment led to treatment decisions. (Author/NB)

Shows how present emphasis on patient autonomy overlooks ways in which intimate relations enable autonomy to function meaningfully and how traditional categories of competent and incompetent discount intimacy as tool for accessing patients' subjective experiences. Urges intimate associations to mark moral boundaries for autonomy because they…

Describes the Neighborhood Family (NF), which is based on the premise that older persons can create a self-managed social support network. Arising from community organization of low-income elderly, the model combines a kin-like supportive community, a multipurpose service and activities center, minimal staff, and indigenous decision- making.…