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Informed consent in dental care and research for the older adult population: A systematic review

https://doi.org/10.1016/j.adaj.2016.11.019Get rights and content

Abstract

Background

Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue.

Methods

The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research.

Results

The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 29 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical conditions, and only 3 involved consent related to dental care or research.

Conclusions

Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research.

Practical Implications

This review is the first attempt, to the authors’ knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients.

Section snippets

Methods

We completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.12 We developed 3 research questions to guide this systematic review:

  • ⁃

    When is an elderly person capable of providing his or her own consent?

  • ⁃

    Is the practice of obtaining informed consent in elderly patients for the provision of dental care or treatment different from that for other medical care?

  • ⁃

    Is the practice of obtaining informed consent in elderly patients for

Study identification and inclusion

We identified 14,448 articles through electronic database searches (Figure). We excluded articles published before 2005 (n = 3,575). We screened titles and abstracts for 10,873 articles, and we excluded 10,768 on the basis of the inclusion criteria. Of the 105 remaining articles, we excluded 25 either for being duplicates or for not satisfying the inclusion criteria, resulting in a final set of 80 articles13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35

Discussion

The investigators in the 80 articles included in this systematic review discussed informed consent substantively—that is, beyond noting that consent was obtained from the patient or participant. However, investigators in only 3 of the 80 articles discussed consent related to dentistry in the geriatric population.70, 78, 81 Most of the studies included in this review focused on capacity assessment and patient understanding. Decision-making capacity, 1 of the principal pillars of valid informed

Conclusions

Although health care professionals and researchers recognize the importance of respecting patients’ personal beliefs, values, and preferences, findings from our review suggest that the topic of informed consent in geriatric dentistry rarely is studied or discussed in the literature. Furthermore, available information is insufficient to compare consent issues adequately in dental settings with those in other medical settings. Topic areas that could benefit from additional study and substantially

Dr. Mukherjee is a dental public health fellow, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.

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    • Cited by (0)

    Dr. Mukherjee is a dental public health fellow, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.

    Ms. Livinski is an informationist, National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, MD.

    Dr. Millum is a bioethicist, Clinical Center Department of Bioethics and Fogarty International Center, National Institutes of Health, Bethesda, MD.

    Dr. Chamut is a dental public health fellow, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.

    Dr. Boroumand is a dental public health consultant, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.

    Dr. Iafolla is a supervisory health policy analyst, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.

    Dr. Adesanya is an oral health science policy analyst, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.

    Dr. Dye is a dental epidemiology officer, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, 31 Center Dr., Suite 5B55, Bethesda, MD 20892-2190.

    Disclosure. None of the authors reported any disclosures.

    This review was supported by the National Institutes of Health, and all authors were paid a salary by the National Institutes of Health.

    The authors prepared this manuscript as a result of a call for papers exploring geriatric issues in dentistry by the American Dental Association’s Council on Access, Prevention and Interprofessional Relations’ (now known as the Council on Advocacy for Access and Prevention's) National Eldercare Advisory Committee in 2015. The authors acknowledge the committee for their guidance and comments.

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    Published by Elsevier Inc. on behalf of the American Dental Association.