{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:22:51Z","timestamp":1787761371250,"version":"build-2784847793"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Australian J Rural Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This commentary examines how guardianship legislation interacts with the practical realities of providing care to older adults with cognitive decline in rural New South Wales. It aims to highlight systemic inequities arising from geographic isolation, workforce limitations and medico\u2010legal uncertainty, and proposes reforms that align guardianship practice with the principles of autonomy, dignity and supported decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>In Australia, substitute decision\u2010making for adults lacking capacity is governed by state guardianship law and Commonwealth\u2010aged care regulation. Although these frameworks are designed to protect vulnerable individuals, their implementation in rural hospitals is often constrained by access to Consultation\u2010Liaison (CL) Psychiatry, restricted administrative support, and delayed access to tribunal processes. These pressures contribute to inconsistent interpretation of guardianship powers, prolonged hospitalisation, and uncertainty around restrictive practice. The Royal Commission into Aged Care Quality and Safety called for nationally consistent rights\u2010based decision\u2010making but did not fully address the unique barriers faced in rural settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach<\/jats:title>\n                    <jats:p>Drawing on three illustrative clinical vignettes from a rural CL Psychiatry service, this commentary explores how legislative ambiguity and resource scarcity shape substitute decision\u2010making in everyday clinical practice. The discussion integrates medico\u2010legal analysis, CL Psychiatry perspectives and rural health literature to identify critical gaps in knowledge, access and coordination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Improving guardianship practice in rural hospitals requires investments in clinical education, streamlined medico\u2010legal and psychiatric support, and coherent legislative alignment between state and Commonwealth frameworks. Addressing these inequities is essential to ensuring that the protections embedded in guardianship law translate into timely, person\u2010centred care for older adults living in rural Australia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajr.70239","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:03:08Z","timestamp":1785992588000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Geography of Guardianship: A Rural Psychiatry Perspective on Decision\u2010Making for Older Adults With Cognitive Decline"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7821-5958","authenticated-orcid":false,"given":"Petula Taara","family":"Hamer","sequence":"first","affiliation":[{"name":"Dubbo Base Hospital Western New South Wales Local Health District  Dubbo New South Wales Australia"},{"name":"The University of Sydney School of Rural Health, Dubbo Campus  Dubbo New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina","family":"Haysom","sequence":"additional","affiliation":[{"name":"South East Sydney Local Health District Clinical Ethics Committee  Randwick New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Sheahan","sequence":"additional","affiliation":[{"name":"South East Sydney Local Health District  Randwick New South Wales Australia"},{"name":"SPHCM, St George Clinical School, UNSW Medicine University of New South Wales  Randwick New South Wales Australia"},{"name":"Sydney Health Ethics, School of Medicine University of Sydney  Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5382-5700","authenticated-orcid":false,"given":"Duncan","family":"George","sequence":"additional","affiliation":[{"name":"School of Rural Health, Faculty of Medicine and Health University of Sydney  Camperdown New South Wales Australia"},{"name":"School of Psychiatry, Faculty of Medicine University of New South Wales  Sydney New South Wales Australia"},{"name":"Dubbo Base Hospital  Dubbo New South Wales Australia"},{"name":"Consultation Liaison Psychiatry The Albion Centre &amp; Prince of Wales Hospital  Randwick New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_12_3_1","unstructured":"R.Diller \u201cDecision\u2010Making Supports and Cognitive Decline \u201dCase Western Reserve University School of Law Scholarly Commons35 no. 1 (2025) https:\/\/scholarlycommons.law.case.edu\/healthmatrix\/vol35\/iss1\/6."},{"key":"e_1_2_12_4_1","volume-title":"Final Report: Care, Dignity and Respect: Volume 1 Summary and Recommendations","author":"Royal Commissions","year":"2021"},{"key":"e_1_2_12_5_1","volume-title":"Law, Health Care, and the Aging Brain and Body","author":"Duffy J.","year":"2026"},{"key":"e_1_2_12_6_1","unstructured":"\u201cGuardianship Act 1987 No 257 \u201d(2021) https:\/\/legislation.nsw.gov.au\/view\/whole\/html\/inforce\/current\/act\u20101987\u2010257#statusinformation."},{"key":"e_1_2_12_7_1","first-page":"11","article-title":"Planning Ahead by Appointing and Enduring Guardian","volume":"1","author":"Rogers L.","year":"2002","journal-title":"Elder Law Review"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajs4.295"},{"issue":"2","key":"e_1_2_12_9_1","first-page":"389","article-title":"Supported Decision\u2010Making for People Living With Dementia: An Examination of Four Australian Guardianship Laws","volume":"28","author":"Blake M.","year":"2021","journal-title":"Journal of Law and Medicine"},{"key":"e_1_2_12_10_1","volume-title":"Parliamentary Research Service","author":"Stewart C.","year":"2025"},{"issue":"2","key":"e_1_2_12_11_1","first-page":"134","article-title":"Consultation\u2010Liaison Psychiatry and the Assessment of Capacity in Older Inpatients: Systematic Review","volume":"29","author":"McKay R.","year":"2021","journal-title":"Australasian Psychiatry"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.946234"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2021.103979"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/13218719.2023.2214937"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.112.123976"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12960\u2010018\u20100271\u20102"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12222250"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326\u20105377.2009.tb02700.x"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajr.13090"},{"key":"e_1_2_12_20_1","volume-title":"Review of the Guardianship Act 1987 (Report No. 145)","author":"NSW Law Reform Commission","year":"2018"},{"key":"e_1_2_12_21_1","volume-title":"Winston Churchill Trust","author":"Chesterman J.","year":"2013"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010118\u20103\u2010199302010\u201000011"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(13)60688\u20101"},{"key":"e_1_2_12_24_1","volume-title":"Final Report: Care, Dignity and Respect: Volume 3A the New System","author":"Royal Commissions","year":"2021"},{"key":"e_1_2_12_25_1","volume-title":"Final Report: Care, Dignity and Respect: Executive Summary","author":"Royal Commissions","year":"2021"}],"container-title":["Australian Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajr.70239","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ajr.70239","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajr.70239","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:41:45Z","timestamp":1787758905000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ajr.70239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/ajr.70239"],"URL":"https:\/\/doi.org\/10.1111\/ajr.70239","archive":["Portico"],"relation":{},"ISSN":["1038-5282","1440-1584"],"issn-type":[{"value":"1038-5282","type":"print"},{"value":"1440-1584","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2025-12-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70239"}}