ETHICO-LEGAL CONSIDERATIONS IN THE

CARE OF OLDER ADULT

LAWS AFFECTING SENIOR
CITIZENS
 AN ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS TO
RA 7432 NATION BUILDING. GRAND BENEFITS AND SPECIAL PRIVILEGES AND FOR
OTHER PURPOSES

PRIVILEGES FOR THE SENIOR CITIZENS

• Grant of twenty percent (20%) discount from all establishments (transportation, hotel, lodging
establishment, restaurant, recreation, medicine, places of culture, leisure, and amusement or such amount
determined by NEDA)
• Exemption from the payment of individual income taxes (income of not more than PHP60,000 per annum)
• Exemption from training fees for socioeconomic programs by the OSCA as part of its work
• Free medical and dental services
RETIREMENT BENEFITS
• Benefits should be at par with the current scale enjoyed by those in actual service
THE OFFICE FOR SENIOR CITIZENS AFFAIR (OSCA)
• Plan, implement and monitor yearly work programs in pursuance of the objectives of this Act;
• to draw up a list of available and required services which the senior citizens can provide
• to maintain and regularly update on a quarterly basis the list of senior citizens and to issue nationally
uniform individual identification cards which shall be valid anywhere in the country
• to service as a general information and liaison center to serve the needs of the senior citizens
 AN ACT GRANTING ADDITIONAL BENEFITS AND PRIVILEGES TO SENIOR
RA 9257 CITIZENS AMENDING FOR THE PURPOSE RA 7432
"EXPANDED SENIOR CITIZENS ACT OF 2003"
PRIVILEGES FOR THE SENIOR CITIZENS
• The grant of twenty percent (20%) discount in fare for domestic air and sea travel
• The grant of twenty percent (20%) discount in public railways, skyways, and bus fare
• Provision of express lanes in all commercial and government establishment; priority should be
given in the absence thereof
• Educational assistance to senior citizens to pursue post secondary, tertiary, post-tertiary, as
well as vocational or technical education in both public and private schools
• To the extent possible, the government may grant special discounts in special programs on the
purchase of basic commodities

In the availment of the privileges, the senior citizen may submit as proof of his/her entitlement
thereto any of the following:
• an ID issued by the city or municipal mayor or of the barangay captain
• passport
• other documents that establish that the senior is a citizen of the Republic and is at least 60
years old
 AN ACT GRANTING ADDITIONAL BENEFITS AND PRIVILEGES TO SENIOR
RA 9994 CITIZENS AMENDING FOR THE PURPOSE RA 9257
"EXPANDED SENIOR CITIZENS ACT OF 2010"

PRIVILEGES FOR THE SENIOR CITIZENS

• The grant of twenty percent (20%) discount and exemption from the VAT, on the sale of the
following goods and services from all establishments:
• on the purchase of medicines, including influenza and pneumococcal vaccines
• on the professional fees of attending physician/s in all medical facilities
• on the professional fees of licensed professional health providing home health care services
• on diagnostic and laboratory fees in all medical facilities
• in actual fare for land transportation travel in PUBs, PUJs, taxis, AUVs, shuttle services, and
public railways (LRT, MRT, PNR)
• on the utilization of services in hotels and similar lodging establishments
• on funeral and burial services for the death of SC
• The grant of a minimum five percent (5%) discount to the monthly utilization of water and
electricity (registered under the name of the SC)
• Free vaccination against the influenza virus and pneumococcal disease for indigent SC
• Social Pension for indigent SC (500.00/month)
 MEDICATIONS OF OLDER ADULTS
POLYPHARMACY
POLYPHARMACY: the prescription, administration, or use of more medications than are clinically indicated
(5 or more medications)

REASONS:
• The high prevalence of health conditions in the older population causes them to use a large number and
variety of medications
• Some elderlies see more than one provider for treatment

MOST COMMONLY USED DRUGS BY THE OLDER POPULATION:

• Cardiovascular agents
• Antihypertensives
• Analgesics
• Antiarthritic agents
• Sedatives
• Tranquilizers
• Laxatives
• Antacids

EFFECTS:
• can cause adverse effects (confusion, dizziness, falls, and fluid and electrolyte imbalance
• increase risk of drig to drug interactions, drug to food interactions, drug duplicates, drug errors
 TOOLS USED FOR ELDERLY MEDICATIONS
STOPP (Screening Tool of Older Person's potentially
inappropriate Prescriptions: prescriptions that are potentially
inappropriate in persons' age >65

START (Screening Tool to Alert doctors to Right Treatment):

medications that should be considered for people >65 where
no contraindications exist
 SMART Acronym for Medication Assessment
S - Schedule
M - Monitor
A - Adherence
R - Review
T - Teach

Patient's RIGHT in Medication Administration

R Patient
Medication
I Amount
G Dosage Form
Route
H Time
Documentation
T
 ETHICAL PRINCIPLES
Helps determine right and wrong courses of action

01 BENEFICENCE o3 FIDELITY AND VERACITY

• to do good for patients • Fidelity: to respect our words and duty
• make sound decisions that serve the to our patients
patient's best interests • Veracity: truthfulness

02 NONMALEFICENCE 04 AUTONOMY
• to respect patients' freedom, preference,
• to prevent harm to patients
• not performing an act that causes harm and rights
• ensure and protect their right to provide
informed consent

03 JUSTICE 04 CONFIDENTIALITY
• to be fair, treat people equally, and give • to respect the privacy of patients
patients the service they need
CULTURAL
CONSIDERATIONS
• The belief that individuals have the right
to make their own decisions regardless of
their sex and should be empowered to do
so

• Women are equal to men

• Prayer is a beneficial supplement to

medical treatment

• People have the right to have the

confidentiality of their health information
protected, even from relatives
LONG-TERM CARE

• a collection of health, personal, and social services

provided over a prolonged period to compensate
for loss of function due to chronic or mental
disability

• as life expectancy and the size of older adult

population increases, the possibility of a person
entering a nursing facility increases

• supports older adults in two distinct aspects:

⚬ ADL'S
⚬ IADL's
PALLIATIVE CARE

• aims to improve the quality of life for both the

patient with serious illness and the family
• focuses on providing relief from symptoms, pain,
and stress of a serious illness
• Special Palliative Care: consists of care by an
interprofessional team of physicians, nurses, social
workers, chaplains, and other individuals with
expertise in palliative medicine
• Key Components:
⚬ symptom management
⚬ coordination of care
⚬ communication about goals of care and
advanced care planning (ACP)
⚬ caregiver support
⚬ referral to specialist palliative care teams
 advance directives
• written documents that state a patient's
preferences for addressing future medical
decisions
• can be executed at any time by a competent
adult person and go into effect when the
person is no longer capable of making health
care decision

DO NOT
RESUSCITATE
• make sure that DNR are legally sound
• must be written and signed on the physician's
order sheet to be valid
 END-OF-life care

• period when recovery from illness is not expected, death

is anticipated, and focus is on comfort

HOSPICE CARE
• it is a way of caring for terminally ill individuals and their
families
• aids in adding quality and meaning into the remaining
period of life
• it involves:
⚬ pain relief
⚬ symptom control
⚬ home care and institutional care coordinated among
an interdisciplinary team
⚬ social work and counseling services
⚬ medical equipment and supplies
⚬ volunteer assistance and support
⚬ bereavement follow-up and counseling
 • it is the essence of our being that transcends and

SPIRITUALITY connects us to the Divine and other living organisms

SPIRITUAL NEEDS
LOVE meaning and purpose HOPE
People need to feel that they are It is the expectation for something in
cared for and can offer caring Life experiences (both good and bad) the duture.
feelings make sense and have served a
purpose.
dignity
GratituDe
Older people derive a sense of value
FORGIVENESS Older individuals may benefit from a
and worht through their connection
For older adults, forgiveness can guided review of the positive aspect
with God or other higher power
facilitate the important process of of their lives
putting things in order and
achieveing closure to unfinished
business EXPRESSION OF FAITH
TRANSCENDENCE
People need to feel that there is a
reality beyond themselves Disruption in the ability to express
one's faith can lead to one feeling
spiritually unfulfilled
 Nursing involves many situations that could produce conflicts:

ETHICAL
• conflicts between nurses' values and external systems
affecting their decisions
• conflicts between the rights of patients and nurses'

DILEMMAS responsibilities to those patients

• Expanded Role of Nurses

⚬ the wider scope of functions, combined with higher salaries and greater
status, has increased the accountability and responsibility of nurses
• Medical Technology
CHANGES INCREASING ETHICAL DILEMMAS FOR NURSES
⚬ new problems have accompanied the modern advances in the medical
community, such as determining on whom, when, and how this
technology should be used
• New Fiscal Constraints
⚬ Patient's needs are weighed against economic survival, resulting in
some difficult decisions
• Conflict of Interest
• Greater Numbers of Older Adults
⚬ Although older adults' problems and needs are more evident, the ability
and responsibility of society to support these needs are in question
• Assisted Suicide/Euthanasia
• Organ Donation
EASURES TO HELP NURSES MAKE ETHICAL DECISIONS

01 02 03
Encourage patients to express their Identify significant others who Know yourself
desire impact and are impacted

04 05 06
Read Discuss Form an ethics committee

07 08 09
Consult Share Evaluate decisions