Clinics in geriatric medicine
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Clin. Geriatr. Med. · Aug 2016
ReviewHuman Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Older Adults.
Improved survival with combination antiretroviral therapy has led to a dramatic increase in the number of human immunodeficiency virus (HIV)-infected individuals 50 years of age or older such that by 2020 more than 50% of HIV-infected persons in the United States will be above this age. Recent studies confirm that antiretroviral therapy should be offered to all HIV-infected patients regardless of age, symptoms, CD4+ cell count, or HIV viral load. However, when compared with HIV-uninfected populations, even with suppression of measurable HIV replication, older individuals are at greater risk for cardiovascular disease, malignancies, liver disease, and other comorbidities.
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The health challenges prompted by obesity in the older adult population are poorly recognized and understudied. A defined treatment of geriatric obesity is difficult to establish, as it must take into account biological heterogeneity, age-related comorbidities, and functional limitations (sarcopenia/dynapenia). This retrospective article highlights the current understanding of the optimal body mass index (BMI) in later life, addressing appropriate recommendations based on BMI category, age, and health history. The findings of randomized control trials of weight loss/maintenance interventions help one to move closer to evidence-based and appropriately individualized recommendations for body weight management in older adults.
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Clin. Geriatr. Med. · May 2015
ReviewInternational palliative care: Middle East experience as a model for global palliative care.
Care for elderly people with life-limiting illness cannot be delivered primarily by geriatricians or palliative care practitioners. The role of these clinicians is to help carers become adept in palliative care medicine. ⋯ The family bond in the Middle East is strong, but the emotional response to terminal illness may push families to request futile treatments, and physicians to comply. When palliative care is well developed and well understood, it provides a viable alternative to such extreme terminal measures.
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This article describes effective communication strategies in caring for older, seriously ill patients and their surrogates/caregivers. Specific skills in three core functions are highlighted: (i) empathic communication (ii) information provision and (iii) enabling decision making. Empathy skills include using 'NURSE' statements and assuring a continuous relationship. ⋯ Eliciting patients' goals of care is critical in decision making. Surrogates need assistance when making decisions for patients and often themselves have support and information needs. Suggestions are made to ensure patients' and caregivers' needs are met.
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Research shows that early access to palliative care can significantly improve the quality of care for patients with chronic and advanced illnesses and reduce the overall costs of care. However, factors such as poor provider reimbursement mechanisms, inadequate formal education and training, workforce shortages, and low provider acceptance and patient engagement have created barriers to the widespread uptake of palliative care. Expanding access to these services requires their integration into new models of payment and delivery, such as Accountable Care Organizations, an overhaul of formal palliative care education and training, and improved messaging about these services to patients and providers.