Clinics in geriatric medicine
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During the terminal phase of illness, many geriatric patients develop psychiatric complications that subsequently have profound effects on their quality of life. Effective treatment requires the skills of a physician who is experienced in the recognition, assessment, and management of psychiatric complications of terminal care. Specialized knowledge is required, because even the most common psychiatric symptoms (anxiety, depression, and cognitive disorder) may be difficult to diagnose and treat. ⋯ Here, too, specialized knowledge is required in order to know which regimens are likely to yield the most benefits with the least risk of toxicity. Fortunately, a considerable body of knowledge has accumulated over the last few years regarding the management of psychiatric symptoms in terminal care. The challenge for the future is to make sure that this information is applied in the routine clinical care of the terminally ill geriatric patient.
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Pharmacologic therapy is the mainstay of pain management in the terminally ill cancer patient. Upwards of 90% of the pain of cancer can be controlled by relatively simple means (i.e. oral, rectal, or transdermal analgesics). ⋯ Effective management of pain in the elderly requires recognition of age-related changes in drug pharmacokinetics and an awareness of drug side effects that may be particularly problematic in older patients. Careful attention to the basic principles of drug use in the elderly will enhance effective pain management and quality of life.
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Is hospice cost-effective? What is perfectly clear is that hospice care overall provides different care than conventional care for the dying. There is much more home care, aimed at goals of comfort, dignity, and remaining at home, and that care is distributed over longer periods of time. There is less hospital care and less anticancer therapy. ⋯ Other questions offer even more substantial challenges to continuing hospice care as it is now offered and into the future. There are no data to allow a critique of the current structure of hospice services, or to support the link between individual components of service and outcomes. This leaves the hospice concept open to considerable manipulation.(ABSTRACT TRUNCATED)