Clinics in geriatric medicine
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Clin. Geriatr. Med. · May 2000
Review Case ReportsTalking to the older adult about advance directives.
Discussing advance care plans with elderly patients can improve the experience of end-of-life care for patients, families, and health care teams. Specific goals for any particular discussion should be based on patients' particular clinical circumstances. Physicians should focus on patients' overall values and goals and should provide emotional support during the discussion. Decisions made during the advance care planning process should be documented.
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Clin. Geriatr. Med. · May 2000
ReviewNutrition and hydration in terminally ill patients: an update.
Many health care professionals lack knowledge about artificial nutrition and hydration at the end of life or may hold different attitudes about artificial nutrition and hydration compared with other treatments. Consequently, they may convey inaccurate or misleading information to patients or their surrogate decision makers. An updated understanding about artificial nutrition and hydration in light of prevailing medical evidence is presented.
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Gastrointestinal obstruction is associated with nausea, vomiting, and abdominal pain. Antisecretory agents can relieve these symptoms, even in the absence of surgical or mechanical intervention. These medical management approaches are outlined, and recommendations are made.
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Dementia is a common, devastating, and ultimately fatal illness. Although no cure exists for most causes of dementia, palliative interventions for the predictable complications of the illness can effectively reduce the suffering of patients and families. Care of patients with end-stage dementia is clinically and conceptually consistent with hospice and palliative care, and this approach to care for patients with terminal dementia is preferred. Although the 6-month risk for mortality can be predicted (to satisfy current American hospice eligibility requirements), palliative care interventions are appropriate much earlier in the course of deterioration from dementia.
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The benefits and risks for older adults with dementia executing advance directives are discussed. Salient issues related to decision-specific capacity and models for advance planning and end-of-life decisions by cognitively impaired older adults are presented.