BOOK
BMJ Clinical Review: Geriatrics, Mental Health and Social Care
Dr Babita Joyti | Mr Ahmed Hamad
(2016)
Additional Information
Book Details
Abstract
Fall assessment in older people Functional assessment in older people Prescribing for older people Assessing and helping carers of older people Post-acute care and secondary prevention after ischaemic stroke Investigation and management of unintentional weight loss in older adults Management of chronic pain in older adults The management of chronic breathlessness in patients with advanced and terminal illness An introduction to advance care planning in practice Cognitive assessment of older people Dementia Alzheimer's disease Depression in older adults Management of depression in adults Long term treatment of depression with selective serotonin reuptake inhibitors and newer antidepressants Generalized anxiety disorder: diagnosis and treatment Management of seasonal affective disorder Obsessive-compulsive disorder Bipolar disorder Personality disorder Managing and preventing depression in adolescents Use and misuse of drugs and alcohol in adolescence New recreational drugs and the primary care approach to patients who use them Assessment and management of alcohol use disorders Assessing mental capacity: the Mental Capacity Act An introduction to patient decision aids Safeguarding adults at risk of harm
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Book Cover | C | ||
| Title | i | ||
| Copyright | ii | ||
| About the publisher | iii | ||
| About The BMJ | iii | ||
| Contents | iv | ||
| About the editors | vi | ||
| Introduction to Geriatrics, Mental Health and Social Care | vii | ||
| Fall assessment in older people | 1 | ||
| How best to assess risk of falling? | 1 | ||
| Screening and assessment of older people in the community | 1 | ||
| Screening and assessment in hospitals | 1 | ||
| Screening and assessment in nursing and residential care facilities for older people | 2 | ||
| What are the challenges? | 3 | ||
| Conclusion | 4 | ||
| Related links | 5 | ||
| Functional assessment in older people | 6 | ||
| What is an assessment of functional status and why does it matter? | 6 | ||
| How is physical function best assessed? | 6 | ||
| History | 6 | ||
| Clinical examination | 6 | ||
| P (physical condition) | 7 | ||
| U (upper limb function) | 7 | ||
| L (lower limb function) | 7 | ||
| S (sensory) | 8 | ||
| E (environment) | 8 | ||
| Standardised assessment tools | 8 | ||
| How to use the functional assessment | 9 | ||
| What are the challenges? | 9 | ||
| Prescribing for older people | 12 | ||
| Sources and selection criteria | 12 | ||
| What physiological changes occur with ageing? | 12 | ||
| Pharmacokinetic and pharmacodynamic changes | 12 | ||
| Multiple pathology and polypharmacy | 12 | ||
| What is inappropriate prescribing? | 12 | ||
| Which drugs should we avoid in older patients? | 12 | ||
| What drugs should we routinely consider in older patients? | 12 | ||
| How can inappropriate prescribing in older people be reduced? | 13 | ||
| Good prescribing practice | 13 | ||
| Medication review | 13 | ||
| Using as few prescribers as possible | 13 | ||
| Education | 14 | ||
| Electronic prescribing | 14 | ||
| Audit | 14 | ||
| What improvements can we expect in future? | 14 | ||
| Conclusions | 14 | ||
| Assessing and helping carers of older people | 16 | ||
| How do we identify carers? | 16 | ||
| How should a carer assessment be undertaken? | 16 | ||
| What are useful carer interventions? | 16 | ||
| What are the challenges for carer assessment and intervention? | 18 | ||
| Conclusion | 18 | ||
| Related links | 19 | ||
| Post-acute care and secondary prevention after ischaemic stroke | 20 | ||
| How should I assess a patient who has survived a stroke? | 20 | ||
| What kind of care should be delivered in hospital? | 20 | ||
| Evidence of benefit of stroke units | 20 | ||
| What makes a stroke unit? | 21 | ||
| Prevention of venous thrombosis | 21 | ||
| Feeding patients | 21 | ||
| Mobilisation: how soon? | 21 | ||
| Facilitating discharge | 22 | ||
| Antithrombotic following ischaemic stroke | 22 | ||
| How are common complications treated after stroke? | 23 | ||
| What measures help to prevent another stroke? | 24 | ||
| Management of carotid disease | 24 | ||
| How to manage hypertension | 24 | ||
| Treating high cholesterol, diabetes and lifestyle risks | 24 | ||
| Investigation and management of unintentional weight loss in older adults | 27 | ||
| When is unintentional weight loss clinically important? | 27 | ||
| What can cause unintentional weight loss in older adults? | 27 | ||
| Organic causes | 27 | ||
| Psychosocial | 28 | ||
| Cognitive impairment | 28 | ||
| Depression | 28 | ||
| Socioeconomic factors | 28 | ||
| Unknown | 29 | ||
| How is unintentional weight loss in older adults investigated? | 29 | ||
| History | 30 | ||
| Physical examination | 30 | ||
| Baseline investigations | 30 | ||
| Should a negative baseline reassure? | 30 | ||
| Managing unexplained weight loss in elderly people | 31 | ||
| Management of chronic pain in older adults | 34 | ||
| What is chronic pain and how is it caused? | 34 | ||
| Who gets it? | 34 | ||
| How are older patients with chronic pain assessed? | 34 | ||
| History | 34 | ||
| Examination | 35 | ||
| Imaging | 35 | ||
| Assessing pain in older patients with major cognitive impairment | 35 | ||
| What is the approach to management? | 35 | ||
| Social aspects of management | 36 | ||
| Home visits | 36 | ||
| What drug interventions are available? | 36 | ||
| Paracetamol | 37 | ||
| Non-steroidal anti-inflammatory drugs | 37 | ||
| Opioids | 37 | ||
| What psychological interventions are available? | 38 | ||
| Cognitive behavioral therapy | 38 | ||
| Self management programs | 38 | ||
| What rehabilitative and exercise approaches are available? | 39 | ||
| When should patients be referred to a pain specialist? | 39 | ||
| What is the role of mobile health technology? | 39 | ||
| What limitations exist in the evidence base about treatment? | 39 | ||
| The management of chronic breathlessnessin patients with advanced and terminal illness | 42 | ||
| What is breathlessness? | 42 | ||
| How common is it in advanced and terminal illness? | 42 | ||
| What is the impact of breathlessness? | 42 | ||
| How is it measured? | 42 | ||
| How is it evaluated? | 43 | ||
| What is the approach to management? | 43 | ||
| What non-drug interventions are available for refractory breathlessness? | 44 | ||
| Pulmonary rehabilitation | 44 | ||
| Multidisciplinary support services | 44 | ||
| Non-invasive ventilation | 44 | ||
| Other non-drug interventions | 44 | ||
| What drug interventions are available for refractory breathlessness? | 44 | ||
| Opioids | 44 | ||
| Which patients should be treated with opioids? | 45 | ||
| Which opioid dose is needed to relieve chronic breathlessness? | 45 | ||
| How is opioid treatment initiated and managed in practice? | 45 | ||
| Oxygen | 46 | ||
| Other drugs | 46 | ||
| An introduction to advance care planning in practice | 47 | ||
| What are the benefits of advance care planning? | 47 | ||
| What are the risks and barriers to advance care planning? | 48 | ||
| How can we initiate discussions? | 48 | ||
| Practical approaches to communication | 48 | ||
| How does advance care planning fit with the Mental Capacity Act 2005? | 48 | ||
| Mental capacity | 49 | ||
| Best interests | 49 | ||
| What are the potential outcomes of an advance care planning discussion? | 49 | ||
| Advance statements | 49 | ||
| Advance decision to refuse treatment | 49 | ||
| Lasting power of attorney | 50 | ||
| What are electronic palliative care coordination systems? | 50 | ||
| When should advance care planning decisions be reviewed? (see box 1) | 50 | ||
| Related links | 52 | ||
| Cognitive assessment of older people | 53 | ||
| Why does cognitive assessment matter? | 53 | ||
| What is the best way to assess cognition? | 53 | ||
| Observation of the patient | 53 | ||
| Examination | 54 | ||
| Investigations | 54 | ||
| Collateral account from carer | 54 | ||
| Standardised assessments | 54 | ||
| Brief cognitive tests | 55 | ||
| Mini-mental state examination | 55 | ||
| Abbreviated mental test score | 55 | ||
| The general practitioner assessment of cognition (GPCOG) | 55 | ||
| Brief assessment for depression | 55 | ||
| Brief assessment for delirium | 56 | ||
| What are the challenges? | 56 | ||
| Dementia | 58 | ||
| What is the burden of disease? | 58 | ||
| What are the barriers to making a diagnosis early? | 58 | ||
| How can clinicians recognise dementia? | 58 | ||
| How is dementia usually diagnosed? | 58 | ||
| How can clinicians distinguish dementia and depression? | 59 | ||
| Why is it important to determine the cause of dementia? | 59 | ||
| What is the evidence for managing patients with dementia? | 59 | ||
| How can clinicians judge mental capacity? | 59 | ||
| What psychosocial interventions are helpful in dementia? | 60 | ||
| What information do people with dementia and their families need? | 60 | ||
| How should carers be supported? | 60 | ||
| How should behavioural and psychological symptoms in dementia be managed? | 60 | ||
| Conclusion | 60 | ||
| Dementia: timely diagnosis and early intervention | 63 | ||
| Why is timely diagnosis important? | 63 | ||
| How can clinicians recognise dementia? | 63 | ||
| How is dementia diagnosed? | 63 | ||
| The role of primary care | 63 | ||
| The role of secondary care | 64 | ||
| What are the roles of imaging and other investigations? | 64 | ||
| What new investigations are emerging in the diagnosis of dementia? | 65 | ||
| What constitutes best practice in early intervention? | 65 | ||
| Discussing the diagnosis: saying the “D” word | 65 | ||
| What options are available after diagnosis? | 65 | ||
| Drug interventions | 65 | ||
| Non-drug approaches | 65 | ||
| Information provision | 66 | ||
| Discussing the future | 66 | ||
| Caring for family carers | 66 | ||
| Related links | 68 | ||
| Alzheimer’s disease | 69 | ||
| What is Alzheimer’s disease? | 69 | ||
| What is the relation between normal ageing and Alzheimer’s disease? | 69 | ||
| What is the benefit of identifying mild cognitive impairment? | 69 | ||
| How does Alzheimer’s disease present? | 69 | ||
| How do we diagnose and assess Alzheimer’s disease? | 70 | ||
| What is the cause of Alzheimer’s disease? | 70 | ||
| What is the genetic contribution to Alzheimer’s disease? | 70 | ||
| What treatments work for Alzheimer’s disease? | 70 | ||
| Pharmacotherapy | 70 | ||
| Amnesia and activities of daily living | 71 | ||
| How can behavioural and psychological difficulties be managed? | 71 | ||
| General assessment | 71 | ||
| Agitation | 71 | ||
| Depression | 72 | ||
| Psychosis | 72 | ||
| Carers’ needs | 72 | ||
| Is prevention of Alzheimer’s disease possible? | 72 | ||
| Conclusion | 72 | ||
| Depression in older adults | 74 | ||
| What is late life depression and who gets it? | 74 | ||
| How is depression diagnosed in older patients? | 74 | ||
| Is depression more difficult to diagnose in older adults? | 75 | ||
| Does depression increase the risk of dementia? | 75 | ||
| How is late life depression managed? | 76 | ||
| When should I refer? | 76 | ||
| Which medication should be prescribed? | 76 | ||
| What if first line drug treatment doesn’t work? | 77 | ||
| Can older adults benefit from psychological therapy? | 77 | ||
| What is the outlook for older adults with depression? | 77 | ||
| Management of depression in adults | 79 | ||
| Why is depression so difficult to diagnose? | 79 | ||
| What should be taken into account while building a management plan? | 79 | ||
| Which treatment setting? | 79 | ||
| How is depression managed in the acute phase? | 79 | ||
| Psychological treatments | 80 | ||
| Pharmacological treatment | 80 | ||
| Combination of pharmacological and psychological treatments | 81 | ||
| How should treatment efficacy be evaluated? | 81 | ||
| What should be done if patients do not respond to treatment in the acute phase? | 81 | ||
| How is depression treated in a continuation phase? | 81 | ||
| Which patients need maintenance or prophylactic treatment? | 82 | ||
| Long term treatment of depression with selective serotonin reuptake inhibitors and newer antidepressants | 84 | ||
| Do SSRIs reduce the risk of relapse or recurrence of depression? | 84 | ||
| What are the potential harms of long term treatment with SSRIs? | 85 | ||
| Self harm and suicide | 85 | ||
| Discontinuation effects | 85 | ||
| Sexual dysfunction | 85 | ||
| Pregnancy | 85 | ||
| Bleeding disorders | 86 | ||
| Hyponatraemia | 86 | ||
| Cardiovascular effects | 86 | ||
| An evidence based approach to long term treatment with SSRIs and newer antidepressants | 86 | ||
| Generalized anxiety disorder: diagnosis and treatment | 89 | ||
| What is generalized anxiety disorder? | 89 | ||
| Who gets generalized anxiety disorder? | 89 | ||
| How is generalized anxiety disorder diagnosed? | 89 | ||
| Does generalized anxiety disorder occur with other disorders? | 90 | ||
| What is known about the causes? | 90 | ||
| What are the treatment options? | 90 | ||
| What psychosocial treatments can be used? | 90 | ||
| When should drugs be prescribed? | 91 | ||
| Which drugs are effective? | 91 | ||
| Unlicensed treatments used in refractory GAD | 92 | ||
| How long should drugs be continued? | 92 | ||
| When should I refer? | 92 | ||
| Post-traumatic stress disorder | 95 | ||
| What is post-traumatic stress disorder (PTSD)? | 95 | ||
| How common is PTSD? | 95 | ||
| How does PTSD present? | 95 | ||
| How is PTSD diagnosed? | 95 | ||
| Can PTSD be prevented? | 95 | ||
| Psychological interventions | 95 | ||
| Drug interventions | 95 | ||
| Prevention after large scale traumatic events | 95 | ||
| Can PTSD be treated? | 95 | ||
| Psychological therapy | 95 | ||
| Self help programmes | 96 | ||
| Drug treatment | 96 | ||
| Combination therapy | 97 | ||
| How should PTSD and comorbidity be managed? | 97 | ||
| What is the prognosis in PTSD? | 97 | ||
| Are there emerging options to prevent and treat PTSD? | 97 | ||
| Management of seasonal affective disorder | 100 | ||
| About SAD | 100 | ||
| What causes SAD? | 100 | ||
| Who gets SAD? | 100 | ||
| Clinical course | 100 | ||
| Diagnosis | 100 | ||
| Conventional antidepressants | 100 | ||
| Acute treatment of SAD | 100 | ||
| Prevention of SAD episodes | 100 | ||
| Light therapy | 100 | ||
| Why use light therapy? | 100 | ||
| What does light therapy involve? | 100 | ||
| Assessing light therapy | 101 | ||
| Methodological difficulties | 101 | ||
| Clinical efficacy of light therapy | 101 | ||
| Unwanted effects of light therapy | 101 | ||
| Practicalities of light therapy | 101 | ||
| Regulations | 101 | ||
| Cost | 101 | ||
| Stopping and restarting light therapy | 101 | ||
| Other treatments | 102 | ||
| Cognitive behavioural therapy | 102 | ||
| Self-help and complementary treatments | 102 | ||
| Negative ion generators | 102 | ||
| What do guidelines say? | 102 | ||
| Conclusion | 102 | ||
| Obsessive-compulsive disorder | 105 | ||
| Who gets OCD? | 105 | ||
| What are obsessions and compulsions? | 105 | ||
| How can we identify and diagnose obsessive-compulsive symptoms? | 106 | ||
| What causes OCD? | 106 | ||
| What other conditions are associated with OCD? | 107 | ||
| What treatments are available and how successful are they? | 107 | ||
| Psychological treatment | 107 | ||
| Drug treatment | 107 | ||
| Other treatment | 107 | ||
| Where and how do I refer? | 107 | ||
| Bipolar disorder | 110 | ||
| What is bipolar disorder? | 110 | ||
| Who gets bipolar disorder? | 110 | ||
| What causes bipolar disorder? | 110 | ||
| What makes bipolar disorder so challenging? | 110 | ||
| How is bipolar disorder diagnosed? | 111 | ||
| How do I distinguish between bipolar and unipolar depression? | 111 | ||
| How is bipolar disorder managed? | 111 | ||
| What drugs are effective? | 112 | ||
| What is the role of psychotherapy? | 113 | ||
| When should I refer and how should care be shared? | 113 | ||
| How are episodes of elevated mood managed? | 113 | ||
| How should maintenance or prophylactic treatment be approached? | 114 | ||
| What are the implications of bipolar disorder for women of childbearing age? | 114 | ||
| What are the options when treatments don’t seem to help? | 114 | ||
| What is the outlook for patients with bipolar disorder? | 115 | ||
| Related links | 116 | ||
| Personality disorder | 117 | ||
| What is personality disorder? | 117 | ||
| Why is personality disorder important? | 117 | ||
| How is personality disorder diagnosed? | 117 | ||
| What do we know about the causes of personality disorder? | 118 | ||
| How is personality disorder managed and treated? | 118 | ||
| What are the basic principles of managing personality disorders? | 118 | ||
| Managing borderline personality disorder | 118 | ||
| Specialist treatment | 118 | ||
| Effective management and care coordination | 119 | ||
| Are there any drug treatments available for borderline personality disorder? | 119 | ||
| Managing antisocial personality disorder | 119 | ||
| Specialist treatments | 120 | ||
| Are there any drug treatments available for antisocial personality disorder? | 120 | ||
| Other treatments | 120 | ||
| What are the problems in everyday practice? | 120 | ||
| Suicide risk assessment and intervention in people with mental illness | 123 | ||
| Introduction | 123 | ||
| Epidemiology | 123 | ||
| Inpatients and recent discharge | 123 | ||
| The emergency department | 124 | ||
| Higher suicide risk shortly after clinical contact | 124 | ||
| Suicide risk assessment | 124 | ||
| Does asking about suicide make a patient more likely to act on it? | 124 | ||
| Challenges in risk assessment | 124 | ||
| Shifts in the science of risk assessment scales | 125 | ||
| Conventional risk assessment scales | 125 | ||
| Beck hopelessness scale (BHS) | 125 | ||
| Beck depression inventory (BDI) and the Beck scale for suicide ideation (BSS) | 125 | ||
| Suicide intent scale (SIS) | 125 | ||
| SAD PERSONS scale | 125 | ||
| Suicide assessment scale (SUAS) and Karolinska interpersonal violence scale (KIVS) | 125 | ||
| Newer suicide risk scales | 126 | ||
| Empirically derived tools | 127 | ||
| Manchester self-harm rule | 127 | ||
| ReACT self-harm rule | 127 | ||
| Repeated episodes of self-harm (RESH) score | 127 | ||
| Novel methods of risk assessment | 127 | ||
| Is suicide risk assessment worth while? | 128 | ||
| Guidelines for risk assessment | 128 | ||
| Interventions to reduce suicide in people with mental health problems | 128 | ||
| Pharmacotherapy | 128 | ||
| Antidepressants | 128 | ||
| Self poisoning | 129 | ||
| Link with suicidal behavior | 129 | ||
| Other psychotropic drugs | 129 | ||
| Lithium | 129 | ||
| Antiepileptic drugs | 129 | ||
| Clozapine | 129 | ||
| Ketamine: an emerging drug treatment | 129 | ||
| Electroconvulsive therapy (ECT) | 129 | ||
| Psychotherapy | 130 | ||
| Online methods | 130 | ||
| Follow-up care | 130 | ||
| Conclusions | 131 | ||
| Smoking cessation and reduction in people with chronic mental illness | 135 | ||
| Introduction | 135 | ||
| Sources and selection criteria | 135 | ||
| Schizophrenia | 135 | ||
| Smoking cessation studies | 136 | ||
| Bupropion | 136 | ||
| Varenicline | 137 | ||
| Studies comparing psychosocial treatments | 138 | ||
| Summary of cessation outcomes in smokers with schizophrenia | 139 | ||
| Mechanisms underlying the schizophrenia-smoking comorbidity | 139 | ||
| Reasons for smoking in people with schizophrenia | 139 | ||
| Reasons for relapse | 139 | ||
| Unipolar and bipolar depression | 140 | ||
| Unipolar depression | 140 | ||
| Bipolar depression | 140 | ||
| Mechanisms underlying the depression-smoking comorbidity | 140 | ||
| Effects of withdrawal | 140 | ||
| Reinforcing effects of smoking | 140 | ||
| Other factors that contribute to persistence of smoking | 141 | ||
| Anxiety disorders | 141 | ||
| Mechanisms underlying the anxiety-smoking comorbidity | 141 | ||
| Negative reinforcement models | 141 | ||
| Reasons for relapse | 141 | ||
| PTSD | 142 | ||
| Mechanisms underlying the PTSD-smoking comorbidity | 142 | ||
| Emerging treatments | 142 | ||
| E-cigarettes | 142 | ||
| Regulatory approaches | 142 | ||
| Conclusions | 142 | ||
| Treatment guidelines | 143 | ||
| Managing and preventing depression in adolescents | 147 | ||
| Why is it important to identify adolescent depression? | 147 | ||
| Which adolescents are most at risk of developing a depressive disorder? | 147 | ||
| How is adolescent depression diagnosed? | 147 | ||
| Which treatments work for adolescent depression? | 147 | ||
| Psychological treatments | 148 | ||
| Drugs | 148 | ||
| Treating mild depression in non-specialist settings | 148 | ||
| Treating moderate-severe depression | 148 | ||
| Suicidal risk | 148 | ||
| Can we prevent or delay onset of depression in adolescents? | 148 | ||
| What sorts of prevention strategies might be useful? | 150 | ||
| Conclusion | 150 | ||
| Use and misuse of drugs and alcohol in adolescence | 151 | ||
| Method | 151 | ||
| What constitutes substance misuse? | 151 | ||
| Is substance use increasing? | 151 | ||
| Drugs | 151 | ||
| Alcohol | 151 | ||
| What do we know about rates of misuse and dependence? | 151 | ||
| Does substance misuse impair the developing brain? | 151 | ||
| How dangerous is substance misuse? | 152 | ||
| Management | 152 | ||
| Assessing the problem | 152 | ||
| Does watchful waiting have a role? | 152 | ||
| What active interventions can healthcare staff use? | 152 | ||
| Brief intervention | 152 | ||
| What to advise parents? | 152 | ||
| More sustained intervention by healthcare practitioners | 152 | ||
| An adolescent oriented service | 154 | ||
| Using a range of community systems | 154 | ||
| Adjunctive interventions | 154 | ||
| Childhood attention-deficit/hyperactivity disorder | 156 | ||
| What causes it? | 156 | ||
| What are the current debates and controversies surrounding ADHD? | 156 | ||
| Variation in prevalence and treatment rates | 156 | ||
| Location | 156 | ||
| Cultural expectations of behaviour | 157 | ||
| Classification | 157 | ||
| Involvement of industry | 157 | ||
| Strength of the evidence base | 157 | ||
| How is it assessed and diagnosed? | 157 | ||
| Making the diagnosis | 157 | ||
| How is ADHD treated? | 158 | ||
| Psychosocial interventions for ADHD | 158 | ||
| Parent training for ADHD | 159 | ||
| Social skills training | 159 | ||
| Cognitive training and cognitive behavioural therapy | 159 | ||
| Classroom interventions | 161 | ||
| Dietary advice | 161 | ||
| Drugs | 161 | ||
| Initiation, titration, and monitoring of drug treatment | 164 | ||
| Duration of treatment and managing comorbidities | 164 | ||
| New recreational drugs and the primary care approach to patients who use them | 167 | ||
| What are the characteristics of some of the new drugs? | 167 | ||
| Cathinone stimulants | 167 | ||
| GHB, GBL, and 1,4-butanediol | 167 | ||
| Ketamine | 168 | ||
| Approaching the question of drug use in primary care | 169 | ||
| What is the approach to assessing patients who admit to problems related to drug use? | 170 | ||
| Are psychological interventions and specialist referral needed? | 170 | ||
| Assessment and management of alcohol use disorders | 173 | ||
| How are alcohol use disorders defined? | 173 | ||
| How can alcohol use disorders be identified? | 173 | ||
| What treatments are available for alcohol dependence in the non-specialist setting? | 174 | ||
| Medically assisted withdrawal | 175 | ||
| Mutual aid facilitation | 175 | ||
| Relapse prevention drugs | 176 | ||
| When should people with alcohol use disorders be referred? | 177 | ||
| Assessing mental capacity: the Mental Capacity Act | 179 | ||
| What does the Mental Capacity Act do? | 179 | ||
| Why do I need to know about the Mental Capacity Act? | 179 | ||
| What has the Mental Capacity Act changed? | 179 | ||
| What is the code of practice? | 179 | ||
| What is the independent mental capacity advocates service? | 179 | ||
| What is a lasting power of attorney? | 179 | ||
| What are advance decisions? | 180 | ||
| What is the court of protection? | 180 | ||
| What legal protection do I have under the Mental Capacity Act? | 181 | ||
| How is capacity assessed? | 181 | ||
| How do I decide what is in someone’s best interests? | 181 | ||
| How do the Mental Capacity Act and Mental Health Act interact? | 181 | ||
| An introduction to patient decision aids | 183 | ||
| Decision aids in the context of shared decision making | 183 | ||
| What is a patient decision aid? | 183 | ||
| What is in a decision aid? | 183 | ||
| Evidence | 183 | ||
| Development | 184 | ||
| Use and integration | 184 | ||
| Conclusion | 185 | ||
| Safeguarding adults at risk of harm | 186 | ||
| What is safeguarding adults? | 186 | ||
| Who is considered an adult at risk of harm? | 186 | ||
| When should a health professional suspect abuse? | 186 | ||
| How common is abuse of adults? | 187 | ||
| Who is responsible for protecting vulnerable adults? | 187 | ||
| What factors influence the likelihood of abuse? | 187 | ||
| How should we prevent and respond to abuse? | 188 | ||
| When should I refer? | 188 | ||
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