Ethical aspects of health treatment for the elderly

Uvod: Starostniki v njihovi potrebi po zdravstveni obravnavi in skrbi za svoje zdravje vstopajo v zdravstveni sistem na vseh njegovih ravneh. Spadajo med ranljive skupine prebivalcev. Večkrat se zgodi, da postanejo žrtve različnih oblik nasilja, diskriminacije, izključevanja ipd. Namen: Namen diplomskega dela je predstaviti najpogostejše etične vidike, ki se pojavljajo pri zdravstveni obravnavi starostnikov. Metode dela: Uporabili smo kvalitativen pristop, in sicer deskriptivno metodo s sistematičnim pregledom domače in tuje literature s področja zdravstvene nege in medicine. Časovni okvir je zajemal literaturo od leta 2017 do leta 2022. Ta je bila iskana prek oddaljenega dostopa v podatkovnih bazah CINAHL in MEDLINE in prek iskalnikov PubMed, DiKUL in COBISS.si. Uporabili smo še arhiv Obzornika zdravstvene nege. V končno analizo smo vključili 15 člankov. Rezultati: Odkrili smo tri glavne etične vidike, ki se pojavljajo v zvezi s starostniki: vidik diskriminatorne obravnave, farmakološki vidik in vidik demence in ostale etične vidike. Starizem se pojavlja tako v Sloveniji kot tujini. V času pandemije se je še povečal. Potrjeno je bilo, da ima socialna izolacija negativen vpliv na življenje starostnikov, saj povečuje tveganje za nevrološke in srčno-žilne bolezni, depresijo, upad kognitivnih sposobnosti in smrtnost med starejšimi. Prav tako se je v času pandemije uporabljala kronološka starost kot merilo pri odločanju za zdravljenje. Starejši bolniki so v kliničnih preizkušanjih zdravil in zdravljenja premalo zastopani. Etične dileme sproža tako prisilno jemanje zdravil kot profilaktično zdravljenje z zdravili. Oskrba stanovalcev z napredovalo demenco in bolečinami ob koncu življenja je klinični in etični izziv, saj je zahtevno najti ustrezno ravnotežje analgetikov in razlikovati bolečino od anksioznosti. Odkrili so še, da imajo starostniki nezadovoljene fizične, psihosocialne in duhovne potrebe, kar se povezuje s slabimi izidi pri bolnikih. Razprava in zaključek: Starostna diskriminacija je najbolj pogosto obravnavana tematika v člankih, ki se nanašajo na starostnike. Sledijo še nasilje nad starostniki, demenca in članki iz področja zdravljenja starostnikov. Menimo, da se o starizmu v družbi (posebej v Sloveniji) še vedno premalo razglablja. V javno obravnavo glede starostnikov bi bilo smiselno vključiti strokovno in laično javnost, odločevalce, akademike in raziskovalce. Medicinske sestre ob tem ne smemo pozabiti na našo vlogo zagovornic pacientov.Introduction: Elderly people in their need for medical treatment and care for their health are entering the health care system at all its levels. They belong to vulnerable groups. It often happens that they become victims of various forms of violence, discrimination, exclusion, etc. Purpose: The purpose of this thesis is to present the most common ethical aspects that arise in the medical treatment of the elderly. Methods: We used a qualitative approach, namely a descriptive method with a systematic review of domestic and foreign literature in the field of nursing and medicine. The time frame covered the literature from 2017 to 2022. It was searched through remote access in the CINAHL and MEDLINE databases and through the PubMED, DiKUL and COBISS.si search engines. We also used the archive of Obzornik zdravstvene nege. In the final analysis 15 articles were included. Results: We identified three main ethical aspects that emerge in relation to the elderly: the discriminatory treatment aspect, the pharmacological aspect and the dementia aspect with other ethical aspects. Old age is appearing both in Slovenia and abroad. It increased even more during the pandemic. It has been confirmed that social isolation has a negative impact on the lives of the elderly, as it increases the risk of neurological and cardiovascular diseases, depression, cognitive decline and mortality among the elderly. Also, at the time of the pandemic, chronological age was used as a criterion in deciding on treatment. Elderly patients are underrepresented in clinical trials of drugs and treatments. Ethical dilemmas are triggered by both forced medication and prophylactic drug treatment. Caring for residents with advanced dementia and end-of-life pain is a clinical and ethical challenge, as it is challenging to find the right balance of analgesics and distinguish pain from anxiety. They also found that the elderly have unmet physical, psychosocial and spiritual needs, which is associated with poor outcomes in patients. Discussion and conclusion: Age discrimination is the most frequently discussed topic in articles related to the elderly. This is followed by violence against the elderly, dementia and articles in the field of treatment of the elderly. We believe that there is still too little discussion about old age in society (especially in Slovenia). It would make sense to involve the professional and lay public, decision-makers, academics and researchers in the public hearing on the elderly. At the same time, nurses must not forget their role as advocates for patients