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Compassion not Control © Susan Wehry MD 2016
Compassion not Control Serving At-Risk Older Adults
26TH ANNUAL MAINE GERIATRICS CONFERENCEJUNE 2-3, 2016
BAR HARBOR, MAINE
PRESENTED BYSUSAN WEHRY, M.D.,
CLINICAL ASSOCIATE PROFESSOR OF PSYCHIATRYUNIVERSITY OF NEW ENGLAND COLLEGE OF MEDICINE
Compassion not Control © Susan Wehry MD 2016
Objectives
● Define autonomy, independence, self-
efficacy
● Discuss diminished capacity
● Describe supported decision-making
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Why I Care (so much)
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First, Do No Harm
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Do GoodNOT SAME AS PATERNALISM
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Respect AutonomyEVEN IN FACE OF DIMINISHED CAPACITY
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Advocate FOR SOCIAL JUSTICE
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Why it Matters (Now)
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Cultural traps, stereotypes
& family folklore
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Compassion not Control © Susan Wehry MD 2016
⇧ Guardianship requests
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Eleanor 12
“I don’t want to lose my independence”
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Freedom
Self-sufficiencySelf-reliance
Independence
I can do it myself
I can do it my way
Compassion not Control © Susan Wehry MD 2016
AutonomyCRITICAL CONCEPTS
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Not Independence
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It’s My Right!
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Autonomy
● To choose
● To self-determination
● To be responsible
● Dignity of risk
● To fail
● To privacy
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The right to be left aloneLEGAL DOCTRINE
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“…foolish, unreasonable and even absurd ideas which do not conform…”JUSTICE BURGER
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Conflict → Abandonment
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Threats to autonomy
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Normative Aging Issues
● Biological
● Sensory changes
● Loss of reserve
● Slower recovery
● Increased medication sensitivity
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Compassion not Control © Susan Wehry MD 2016
Normative Aging Issues
● Cognitive
● Sensory impairment
● Attention
● Registration
● ↓ Memory
● More trials
● Less efficient recall
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Compassion not Control © Susan Wehry MD 2016
Normative Aging Issues
● Psychological
● Positive
● Resilient
● Loss
● Developmental tasks
● Goals and values may change
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Compassion not Control © Susan Wehry MD 2016
● Social
● Change in role
● Change in connection
● Less visible
● Risk of abuse, exploitation
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Compassion not Control © Susan Wehry MD 2016
Non-Normative
● Dementia, due to any cause
● Depression
● Substance Use Disorders
● Abuse, neglect, exploitation
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Net result
● Live in fear
● of losing autonomy
● of reprisal
● of losing options
● Anxious when decisions challenged
● May minimize deficits
● Defend independence
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Compassion not Control © Susan Wehry MD 2016
NecessaryBUT NOT SUFFICIENT
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Motivators and TriggersTO TAKE CONTROL
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Fear, Frustration, Filial love
● Safety
● Falls
● Protection from exploitation
● Fear of Decline
● Access to medical care
● Access to services
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Common Triggers
● Treatment refusal
● Non-adherence
● Abuse, neglect, exploitation
● Lifestyle intolerance
● Hospitalization
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Enter: CompassionEMPATHY PLUS RIGHT ACTION
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Empathize, don’t sympathize
● Fear
● Sense of loss
● Sense of risk
● Love
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Support for at risk adultsFINDING BALANCE
ENHANCING SELF EFFICACY
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Enhancing Self-Efficacy
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Compassion not Control © Susan Wehry MD 2016
Self-efficacy
• “What I do makes a difference”
• “I’m in charge”
● of my destiny
• “I am responsible”
● for my actions
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Engage Circles of Support
Family Friends
ProfessionalsPeers
Co-workers
Others
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Identify Health Goals
● “get out of the apartment and back to doing things for myself”
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Create control points
● Time you come
● How you spend time
● Present options
● clearly
● realistically
● without personal bias
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Compassion not Control © Susan Wehry MD 2016
Start the conversation
● Advance planning
● Palliation
● End of life care
● The Five Questions
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Everything you do…
Care transitions
Self-management
Action plans
Care coordination
Riding the busScreenings
…Is an opportunity to enhance or diminish self-efficacy
Partnerships
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WHEN DO WE? WHEN DON’T WE?
“Leave me alone!”
Compassion not Control © Susan Wehry MD 2016
Competency v. Capacity
● Competency
● a legal concept
● Capacity
● a clinical concept
● the ability to “do” something
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Capacity assessments
● Assist best performance
● More than one examination
● Decision-making “good enough”
Compassion not Control © Susan Wehry MD 2016
Supported Decision-Making
Compassion not Control © Susan Wehry MD 2016
In conclusion
● Lead with compassion not control
● Find the balance
● Unite against abuse
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June 15: Take Action
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Thank YouFOR BEING HEREFOR PARTICIPATINGFOR ALL YOU DO
More Questions? Comments?
Please contact me [email protected] my websitewww.susanwehrymd.com
Or join me on Twitter: @CommishVT12 @beingwithaging#changingaging #Oasis2