Harold Parker, BSW, MSW, RSW
Social Worker, Outreach Team,
Southwestern Ontario Regional Geriatric Program,
London, ON.

Laura Diachun, BASc, MD, FRCP(C)
Geriatrician,
Southwestern Ontario Regional Geriatric Program,
London, ON.

As an Outreach Team that provides service to the frail elderly for the Southwestern Ontario Region (10 counties), our ongoing challenge is how to respond to the needs of cognitively-impaired older persons living at some degree of risk. The perception and assessment of risk vary depending upon the lens through which we are looking. A living situation that may be perceived as risky by some may be quite unproblematic to others. Caring family members can often rationalize paternalism toward their elderly loved one so as to err on the side of safety--a value that can often take precedence over issues of quality of life and self-determination. A lifetime of responsible decision-making is no guarantee of the continued exercise of free will at the latter end of the life cycle. The 'assailants' to independence can be many, including paternalism and the presence of disease beyond normal aging, which can affect both function and cognition. It is often unclear where to draw the line between granting the individual the freedom to make poor lifestyle decisions and deeming that someone is exceeding family/community standards of acceptable lifestyle choices.