Journal of the American Geriatrics Society
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Comparative Study
Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture.
To compare the experience of pain and treatment of pain in cognitively impaired and cognitively intact older adults after surgical repair of a hip fracture. ⋯ Pain is treated poorly in older postoperative patients. Cognitive impairment and age strongly influence the amount of analgesic nurses administer to older patients after surgical repair of hip fracture. Provision for patient comfort is a fundamental ethical obligation of healthcare providers. Clinicians need to pursue this goal more aggressively, especially for cognitively impaired, postoperative older adults.
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To assess the outcomes of anesthesia and surgery for men and women 100 years of age and older. ⋯ These data suggest that people 100 years of age and older who have operable diseases or injuries should not be denied surgical interventions because of perceived risks associated with their advanced age.
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Health care for demented older persons presents a range of ethical dilemmas. The disease process affects cognitive abilities, making competency a central issue. The syndrome of dementia carries a complex social overlay that colors perceptions of these patients and of their capacity for making decisions. ⋯ Surveys of actual decision-making practice are contrasted with ethical and legal principles. The challenges inherent to applying the best interests standard are discussed. Despite the pitfalls, this standard offers an opportunity to restore the demented patient's sense of self.
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Randomized Controlled Trial Comparative Study Clinical Trial
A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI.
To test the hypothesis that selected older women with mild-to-moderate stress urinary incontinence (SUI) can learn to demonstrate significantly reduced urine loss in 1 week by intentionally contracting the pelvic floor muscles before and during a cough (a skill we have termed "The Knack"). ⋯ Within 1 week, selected older women with mild-to-moderate SUI can acquire the skill of using a properly-timed pelvic floor muscle contraction to significantly reduce urine leakage during a cough.