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Cognitive citizenship: access to hip surgery for people with dementia

Ruth Graham1

  • 1School of Population and Health Sciences, University of Newcastle upon Tyne, UK. r.h.graham@ncl.ac.uk

Health (London, England : 1997)
|June 18, 2004
PubMed

Insights

People with dementia and chronic hip disease face potential discrimination in accessing surgical services. Current medical evidence may unfairly limit surgical options for cognitively impaired patients.

Area of Science:

  • Gerontology
  • Neurology
  • Orthopedics

Background:

  • Dementia and chronic hip disease prevalence increases with age.
  • An aging UK population will see a rise in individuals with both conditions.
  • Current medical conceptualization may impact surgical access for these patients.

Purpose of the Study:

  • To evaluate how evidence-based medicine conceptualizes patients with dementia and hip disease.
  • To determine if this conceptualization unfairly restricts access to surgical services.
  • To analyze the suitability of existing clinical discourse for surgical viability decisions.

Main Methods:

  • Analysis of published clinical research at the intersection of hip disease and dementia.
  • Evaluation of outcome criteria used to determine surgical patient viability.
  • Assessment of the evidence-base for professional decision-making.

Main Results:

  • Outcome criteria for surgical viability appear to unfairly discriminate against individuals with dementia.
  • This discrimination may limit access to necessary surgical interventions.
  • The current evidence-based culture may promote a problematic model of cognitive citizenship.

Conclusions:

  • Evidence-based medicine may create barriers to surgical care for people with dementia.
  • This potentially infringes upon the health-related citizenship rights of the cognitively impaired.
  • Re-evaluation of outcome criteria is needed to ensure equitable access to surgical services.

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