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Working in a hospital setting, a very common population encountered is that of the older adult. At my current employment setting, geriatric is specifically identified
as any individual age 55 and older. Just having awareness of this fact, alone, is really emphasized with staff so everyone is especially looking for special concerns
that pertain to this particular population when interfacing with them.
Trainings are offered internally annually regarding ways to recognize elder abuse and what reporting measures are required of staff. In addition, the American
Counseling Association (ACA) Code of Ethics discusses how confidentiality may become compromised in the event of foreseeable harm or when the law indicates need for
disclosure. Thus, annual ethics training serve as an additional reminder of the potential need to break confidentiality if suspecting or becoming aware of instances of
elder abuse for the behavioral health professionals on staff. Also, the hospital where I work includes training that addresses when to contact Adult Protective
Services, as well as the legal requirement here in Colorado to notify the police if the abuse involves an individual who is 70 years and older.
In addition to issues of possible abuse, many other ethical issues often come into play with this population. One of which is cognitive impairment and respect for
autonomy and beneficence. The mental decline that can occur later in life with diagnoses of dementia or Alzheimer disease, and the challenge of desiring to respect a
patient’s autonomy and voice but also wanting to ensure they are making sound decisions based upon good insight and judgment is especially challenging. This challenge
is often exacerbated when involved family members have differing perspectives. In addition, in cases where there is no specific impairment, some providers and family
members may erroneously begin to assume the decision-making power needs to be passed along to others simply due to age alone. “The capacity of elderly patients to
participate in the decision-making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their
representatives” (Perez, Lorenzo, Luna, & Osuna, 2007, p. 712). The behavioral health staff at my hospital have been trained to utilize a systems approach that
encourages involvement of all parties in a balance and mediated format, with patient’s consent when possible. It is always assumed that we serve the patient and
his/her wishes first.

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