Articles: aged.
-
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.
-
Due to pharmacokinetic and pharmacodynamic reasons, the elderly are at particular risk of incurring unwanted side effects of drugs commonly used in anaesthesia. The bispectral index (BIS) is an EEG-derived value that measures the sedative component of the anaesthetic state. The BIS could be useful in guiding titration of anaesthetic drugs in the elderly. ⋯ The BIS is a useful guidance for titration of anaesthetic drugs in the elderly. The presence of senile dementia may be a confounding factor in the interpretation of the BIS values during anaesthesia.
-
Management of pain is crucial to the success of any program of care and support for dying patients and their families. Pain can be controlled in more than 90% of older adults. ⋯ Strategies that enable clinicians to prevent and treat the expected complications of nonsteroidal anti-inflammatory and opioid therapies are reviewed. Strategies to change opioid agents or routes to minimize opioid-induced side effects and to provide effective pain relief as death nears are presented.
-
Anesthesiol Clin North America · Mar 2000
ReviewChoosing general versus regional anesthesia for the elderly.
Although clinical perceptions and theoretic considerations suggest regional anesthesia should be safer than general anesthesia in elderly patients, current studies indicate no difference in outcomes. Regional anesthesia may still prove superior to general anesthesia if the right patient population or right endpoints are identified for comparison. A study of consequence of outcome, comparing the two approaches has created an expansion of the definition of anesthesia-related complications.
-
Settings involving the extremes of age and illness are the most complex in ethical deliberation and require sound principles that can be clearly applied to individual situations. This article discusses how one's view of the aging process effects clinical decision making. ⋯ Issues such as informed consent, do not resuscitate orders in the operating room, and controversies in end-of-life palliative care specifically impact the role of the anesthesiologist. Anesthesiologists, as medical professionals in a health care team, have a great stake in ethical decision making and the ethics of health care policy.