Professional Practice, Ethics, Advocacy, and Healthcare Delivery for Older Adults
What the candidate must understand
Core ethical principles: autonomy, beneficence, nonmaleficence, justice, and fidelity. In geriatrics, autonomy is complicated by decision-making capacity, which is task-specific and can fluctuate (e.g., in delirium or early dementia). Capacity is not the same as competence, which is a legal determination. Know the hierarchy of surrogate decision-makers and the role of advance directives and POLST.
Know the principles of informed consent, confidentiality, and mandatory reporting of suspected elder mistreatment (physical, emotional, sexual, financial, neglect, self-neglect). Physical therapists are often mandatory reporters.
Healthcare delivery for older adults includes Medicare parts A, B, C, and D, home health eligibility (homebound status, skilled need, plan of care), skilled nursing facility criteria, and the distinction between restorative and maintenance therapy. Documentation must justify medical necessity and skilled care. Advocacy includes reducing ageism, promoting access, and addressing disparities.
Traps
- Equating a dementia diagnosis with incapacity; capacity is decision-specific.
- Assuming a patient cannot consent because of age or a diagnosis.
- Failing to recognize financial exploitation as mistreatment.
- Confusing Medicare coverage rules, such as maintenance therapy versus restorative therapy.
- Overlooking implicit ageism in goal setting.
Rule of thumb
When capacity is uncertain, ask: can the patient understand the relevant information, appreciate the consequences, reason about options, and express a choice? If any element is missing for the specific decision, involve the surrogate and document the reasoning.