J Am Dent Assoc. 2017 Apr;148(4):211-220. doi: 10.1016/j.adaj.2016.11.019. Epub 2017 Jan 5.
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.
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.
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.
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.
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.
医疗保健和研究中的伦理学基于知情同意的基本原则。然而，老年牙科中的知情同意并未得到很好的记录。老年人健康状况不佳、认知能力下降以及许多老年患者的被动性使问题更加复杂。
作者根据系统评价和荟萃分析的首选报告项目完成了这项系统评价。作者搜索了 PubMed（医学文献在线数据库）、Web of Science、PsycINFO 和 Cochrane Library 数据库。如果研究涉及 65 岁及以上的参与者，并讨论了与医疗保健以外的知情同意相关的主题，则将其纳入研究。作者探讨了牙科和其他生物医学护理和研究中的知情同意问题。
作者根据纳入标准纳入了 80 篇全文文章。在这些研究中，有 33 项是在美国进行的，29 项涉及认知障碍患者的同意问题，29 项是在患有医疗条件的患者中进行的，只有 3 项涉及与牙科护理或研究相关的同意。
知情同意是老年牙科护理和研究中被忽视的话题。在同意程序的理解和实施之间存在很大的知识差距。该领域的额外研究可以帮助解决牙科从业者通常遇到的当代同意问题，并增加老年人群对牙科护理和研究的积极参与。
据作者所知，这是第一次尝试全面确定老年牙科中的知情同意问题。知情同意文献中涵盖适用于老年牙科的关键概念的信息有限。解决这些差距可以帮助牙科保健专业人员处理与老年牙科患者相关的复杂伦理问题。
