At what age do adults stop being adults?

Stacey Finlay is a Registered Nurse in an Acting Sister’s position in Intermediate Care, based in Northern Ireland.  She tweets at @staceylou_18

As a nurse working with older people I feel I often have to provide justification for not automatically disclosing information about care or treatment to a patient’s next of kin.  I feel I have to justify not including next of kin in decision making almost daily and utter words to the effect of “I didn’t discuss it with next of kin as Mrs X is an adult with capacity so I did not need to discuss it with next of kin" so often that I feel I am reading from a script, and it makes me think – if I worked with patients fifty years younger would the same questions be asked? Would there be the same expectation that I should not make any changes to care or have decision making discussions with patients without permission or input from their next of kin if I worked with thirty-year olds rather than eighty-year olds? I think not.

I also do not think I am the only professional working with older people who has had this experience. I have read letters from other clinicians which describe more in-depth consultations and relationships with well intentioned family members than with the patient themselves – sometimes even to the extent of a diagnosis being disclosed only to a family member and not to the patient. The routine societal infantilization of older people is not an innocuous annoyance for professionals like me and poses a risk of harm to the patients we work with. Most professionals, particularly those working with older people, would agree that lengthy admissions are risky for our older population – it puts them at risk of contracting infection, developing delirium and deconditioning – continuing to be admitted once ready for discharge is fraught with risk. Yet, it happens.

All too frequently I see patients who could go home, who want to go home, but their family do not agree with team recommendations or their family members wishes. They feel that their family member returning home would “not be best for them" or that they are not ready and so the team, the family and the patient become engaged in repeated discharge planning meetings and an extended period of admission. The patient inevitably falls prey to one of the risks of lengthy admission and sometimes, they never make it home.

I have never met a family who seek to be involved or consulted about decisions related to the care of their relative with malicious intent. They have all been well intentioned but it’s a situation that I feel can hinder the provision of person-centred care. Being placed in this situation, a situation I have only ever came across in geriatrics, makes me wonder – why as people age do children, or nieces and nephews for some, adopt a paternal role in their older relatives’ lives? At what age do adults stop being adults?

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