Aging Consumer Vulnerabilities Influencing Factors of Acquiescence to Informed Consent

Rapid growth in the older population raises concerns about increasing demands that aging consumers experience in service encounters. In particular, they face challenges of informed consent that require them to make decisions that support their well-being. Building on current knowledge of factors that diminish decision-making capacity with age, this study examines conditions under which aging consumers acquiesce to informed consent, when not fully informed. The conceptual framework and research propositions regarding the key factors influencing consumer vulnerability during the informed consent process are (1) cognitive changes, (2) sensory factors, (3) financial changes and (4) sender and receiver interaction. Theoretical and practical implications of the framework are discussed. ********** Numerous services directed toward aging consumers require some form of informed consent prior to or in the process of service being administered. Health and living care services, including independent/dependent and assisted living, respite, memory, rehabilitation and nursing care for example, all require considerable documentation of consent for treatment and care, as well as consent for restrictions in care. This is also the case for health/life insurance, retirement planning and home financing options like reverse mortgages. Consent forms are often written with dense legal jargon that is difficult to comprehend and emphasizing the priorities of the service provider and less so the interests of the consumer (Hopper et al. 1998). Much is known about the process of informed consent from its widespread practice in the medical arena. An array of regulations, policy statements and laws emphasizing the need for obtaining meaningful informed consent has been directed toward medical and clinical services (Fuller, Dudley, and Blacktop 2002; Leino-Kilpi et al. 2000). The necessity for obtaining informed consent from patients and the implications of failing to do so bears greatly on the risks of fatalities and other irreversible outcomes for the patient. The impact also underscores the invasive nature of these services and the legal and ethical implications involved. However, questions still remain about the practical meaning of consent for the patient and whether meaningful consent is ever achieved in practice. In spite of the growing use of informed consent in noninvasive services (i.e., education, transportation, etc.) the practice of obtaining informed consent from consumers outside medical and clinical services has been less emphasized. Regulations and policies of standards for the content of informed consent documentation in nonmedical services are inconsistent and undefined. Even less understood is the practice and process of obtaining informed consent from vulnerable consumers whose decision making capacities and sensory competencies may be compromised as a result of aging. Research has shown that consumers lack comprehension of the information given during informed consent discussions (Taub, Kline, and Baker 1981) and a majority of consent documents used in health-related situations are incomprehensible to most patients (Hopper et al. 1998). While the difficulty of incomprehensible informed consent documents and discussion may also exist for other groups of consumers, the problems may be of greater significance for aging consumers. Some aging consumers are faced with declining cognitive, biological and physiological abilities which heighten the feelings of vulnerability, especially in health-related service encounters that require informed consent (Pak and Kambil 2007). Evidence exists that in problem solving, some aging consumers may deliberate less, others may have less memory capacity for short-term recall, and some may lack speed in information processing (Johnson 1990; Salthouse 1996). Yet research examining the impact of imposing informed consent on aging consumers in service encounters is sparse. …