Our keynote speaker
Associate Professor Carmelle Peisah
Bio: Old Age Psychiatrist; Clinical Director Specialised Mental Health Services for Older People, Northern Sydney Local Health District, Australia; President Capacity Australia; Conjoint Associate Professor, University NSW; Clinical Associate Professor Sydney University; Chair of the International Psychogeriatric Association (IPA) Taskforce/Shared Interest Group on Capacity; Co-author with Mr Nick O’Neill of the textbook “Capacity and the Law” http://www.austlii.edu.au/au/journals/SydUPLawBk/2011/1.html; multiple publications and presentations on Capacity; acted as an expert both in Australia and internationally in >300 cases related to capacity; consultant to state and national groups on a range of capacity issues including end of life decision making, informed consent for psychotropics, and elder abuse; lead in a national research project with Australian Banking Industry looking at knowledge translation and awareness raising to prevent financial abuse.
Title: Supported decision making: putting our actions where our mouth is in human rights
Abstract: The United Nations Convention on the Rights of Persons with Disabilities (CORPD) entered into force in May 2008, and has since been signed by 123 countries. Article 12 recommends signatory parties take appropriate measures to provide access by persons with disabilities to the support they require in exercising their legal capacity. This paper will discuss opportunities for health care professionals to meet these obligations by supporting the decision making of people with decision-making disability. Notwithstanding the right to presumption of capacity for all adults, when that presumption is rebutted and triggers exist for the assessment of capacity, the priority of such assessment should be to maximize opportunities for supported decision- making, using the ASK ME model. This model recommends a step wise approach to assessment and support involving: (i) Assessing strengths and deficits; (ii) Simplifying the task; (iii) Knowing the person; (iv) Maximizing the ability to understand; and (v) Enabling participation in the discussion. Practical applications of this model in health, finance and legal settings will be provided.
Our plenary speakers:
Dr Elsie Hui
Bio: Consultant and Chief of Service of the Department of Medicine and Geriatrics at Shatin Hospital, as well as the Leader for Clinical Services, Division of Geriatrics at the Chinese University of Hong Kong. Responsible for a convalescent medical unit which serves patients transferred from acute care and oversees community geriatric services which support residential care homes for the elderly and high risk elderly who live at home. Works with the Hong Kong Hospital Authority in planning new services for integrated and community care, geriatric day hospitals and end of life care. Published over 50 peer-reviewed international journals; latest research interests include end of life care and applications of innovative technologies in the care of older persons with cognitive impairment.
Title: End of life decision-making in residential care homes
Abstract: The paper will describe the End Of Life care model in nursing homes in Hong Kong. The challenges of navigating services around issues such as the automatic rendering of cases as Coronial Case when deaths occur outside of hospital and the novelty of concepts such as advance care planning in Hong Kong society will be discussed. The experiences in engaging patients, family and cares in advance Care Planning and accepting End of life care will be shared.
Associate Professor Joshua Tsoh, Honorary Clinical Associate Professor Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region (HKSAR), China
Title: Guardianship laws and surrogate decision-making practices in Hong Kong and selected Asia-Pacific Rim Nations: A comparison and the ways forward
Abstract: Guardianship and surrogate decision-making processes rely on a complex interplay between judicial and health systems, culture and family traditions. In this presentation, the current guardianship laws are compared, and jurisdictional variations in proxy decision processes to support persons with decision-making disabilities (DMDs) and health and social needs in Hong Kong SAR, Mainland China, Japan, Thailand and Australia are explored, with the aim to enhance mutual understanding of diverse approaches to guardianship and administration law, and as a step towards the ultimate goals to promote autonomy, proper access to care and dignity of persons with DMDs across the nations, an important task for us multidisciplinary professionals especially as according to the WHO global population ageing is accelerating at an unprecedented pace and is most prominent in the Asia Pacific Region.
Dr Jin Narumoto, Associate Professor, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Japan Science and Technology Agency, Center of Innovation Program
And Ms Yuka Kato, Assistant Professor, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Title: J-DECS: Health care decision-making support for people with dementia in Japan
Abstract: Capacity assessment and support are especially important in highly aged societies to help older people with their decision making for healthcare, finance and other economic activities. In Japan, such systems have not been developed because hitherto, families have made decisions on behalf of older people. However, recent growing trends of aging and increasing nuclear family composition have increased the need for such a system. Here, we will present the concept and purpose of the project which aims to develop a new center to develop support systems for older adults in economic activities through collaboration of various professionals in law, technology and medicine with private companies. Also, we will present data from our research about consent capacity to treatment of anti-dementia drugs in Alzheimer’s disease.
Dr Yumiko Arai, Departmental Head, Department of Gerontological Policy National Center for Gerontology and Geriatrics
Bio: Dr. Yumiko Arai is the head of Department of Gerontological Policy at the National Center for Geriatrics and Gerontology (NCGG). She developed her strong desire to work with family caregivers when she was young. As a medical student trainee in Neurology in Sendai city in Japan, she was assigned to see a patient suffering from ALS and his family members for 2 months. This experience made her aware of the fact that there was a lack of systems in Japan which support family caregivers of patients with a chronic and degenerative disease. Not only, a lack of system, but also there was a lack of awareness of the fact that family caregiving can be a burden partly due to the long standing Confucian beliefs. She subsequently developed her strong desire to contribute to family caregivers by providing scientific evidence which will guide long-term policies through research.
Having done a residency in psychiatry in Tokyo, she subsequently obtained training in public health in Edinburgh, Scotland. She received the outstanding researcher award conferred by the Japan Epidemiological Association in 2004 and the Japan Medical Association in 2005. She also received the Best Presentation Award conferred by International Psychogeriatric Association (IPA) in Oct., 2013. She published a manual for patients with dementia and their family caregivers where the patient must give up driving due to dementia.
Title: When driving capacity is lost: a support manual for caregivers
Abstract: Older people with dementia are eventually forced to give up driving as their symptoms progress. Making the decision to stop driving involves significant difficulties for the patients, and also their family caregivers. One reason for this is that an inability to drive can significantly hinder everyday life if driving is a crucial means of transportation both for the patient and for their family, and so there might be strong resistance to the decision. To ease such difficulties among caregivers and patients, we created a 35 page manual with the title ‘Supporting family caregivers of older drivers with dementia’ (hereafter referred to as ‘the manual’). In order for the manual to be used widely, we made it available as a PDF file, which can be downloaded at no cost from the homepage of our department website since February 2010. We also sent details of the manual and its availability to professionals in charge of welfare for older people in all municipalities nationwide. Consequently, this manual has received nationwide coverage. Japan’s NHK (equivalent to the BBC in the UK) ran a news item about this manual during a nationwide news program. Also, it has featured in various newspapers. Cumulatively, it has been accessed over 99,000 times over the last four years.
We subsequently conducted a postal survey of all municipalities (n=1,750), in order to investigate their utilization of the manual (number of responses=1,067). As a result, 88 % of the municipalities answered that they found information that they wanted or needed.
Dr Wai Ming Wong, Geriatrician, Tuen Mun Hospital, Hospital Authority of HK
Title: Hong Kong Mental Health Ordinance – a local geriatrician’s perspectives
Abstract: The laws providing the framework for acting and making decisions on behalf of adults who lack capacity in Hong Kong is mainly the Mental Health Ordinance (MHO). As a local geriatrician practising in a public hospital, we find that there are difficulties in applying the laws. With the development of Mental Capacity Act (MAC) in England and Wales in 2005, I found that it has its own merits for us to learn. In this presentation, I will compare and contrast the MHO and MAC; hoping to bring new messages for future reform to be made.