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Clinical issues in old age: the challenges of geriatric medicine
- Author:
- BAYER Anthony
- Journal article citation:
- Quality in Ageing and Older Adults, 12(1), March 2011, pp.44-49.
- Publisher:
- Emerald
Geriatric medicine is the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in older people. Rather than being defined by some arbitrary cut-off in chronological age, it recognises that most older people, especially the ‘young-old’, are in good health for most of the time. They are likely to benefit from standard medical management by generalists. Geriatricians focus on the more challenging patients – those older people who are physically and cognitively frail, many of whom will be among the growing numbers of the ‘old-old’. This population is characterised by non-specific presentation of illness, functional dependency and a need for a multi-disciplinary approach to care and cautious use of drug therapy. Drawing on publications from the department of geriatric medicine in Cardiff, this article illustrates important aspects of clinical care of older people and highlights the need for better recognition and prevention, better assessment and diagnosis and better therapeutic tools to manage acute and chronic illness in old age.
Religion and survival in a secular region. a twenty year follow-up of 734 Danish adults born in 1914
- Authors:
- LA COUR Peter, AYLAND Kirsten, SCHHULZ-LARSEN Kirsten
- Journal article citation:
- Social Science and Medicine, 62(1), January 2006, pp.157-164.
- Publisher:
- Elsevier
The aim of the study was to analyse associations of religiosity and mortality in a secular region. The sample consisted of 734 Danish, community dwelling elderly persons, living in a secular culture, and all aged 70 when primary data were collected. Secondary data consisted of a 20 year follow-up on vital status or exact age of death. The study was designed to be highly comparable to studies conducted in more religious environments in order to compare results. Three variables of religion were investigated in relation to survival: importance of affiliation, church attendance and listening to religious media. Relative hazards (RH) of dying were controlled in models including gender, education, medical and mental health, social relations, help given and received, and health behaviour. The results showed significant and positive associations between claiming religious affiliation important and survival (relative hazard of dying=RH .70; 95% CI .58–.85) and church attendance and survival (RH .73; 95% CI .64–.87). Results decreased and only stayed significant regarding church attendance when controlled for covariates. Nearly all significant effects were seen in women, but not in men. The effect size of the full sample is less than in more religious environments in United States samples. Although the positive overall RHs are comparable to those of other studies, the mediating variables and pathways of effects seem dissimilar in this sample from a secular environment. Receiving and especially giving help to others are suggested as variables of explanatory value.
Creating compassionate care within the hospital intensive care unit: beyond positivism and toward wisdom and responsibility
- Author:
- WAX Murray L.
- Journal article citation:
- Qualitative Research, 3(1), April 2003, pp.119-138.
- Publisher:
- Sage
Of deaths in the US, an increasing proportion occur within hospital intensive care units amidst miraculous medical technology. A positivist ethos dominates. As patients are transformed into 'cases', they lose social identity, and their dying becomes a medical defeat, rather than a natural and social process. Families encounter sedated intubated specimens rather than social persons from whom they wish ceremonially to depart. In response to these problems, there are ongoing efforts at transformation and remediation.
Withdrawing life support and resolution of conflict with families
- Authors:
- WAY Jenny, BACK Anthony L., CURTIS J. Randall
- Journal article citation:
- British Medical Journal, 7.12.02, 2002, pp.1342-1345.
- Publisher:
- British Medical Association
The goal of withdrawing life support when death is expected is to remove treatments that are no longer desired or indicated and that do not provide comfort to the patient. Any treatment may be withheld or withdrawn, and most ethicists concur that there is no difference between withholding or withdrawing life supportive treatments. The families' emotional reactions and needs also need to be anticipated. Families may believe they are causing the patient's death by agreeing to withdraw life support. Feelings of guilt should be explored directly and discussed openly. Relatives may feel less burdened by guilt if physicians strongly recommend that life support be withdrawn rather than asking the family to make the decision. Focusing the family on what the patient would want rather than what the family wants may also reduce the family burden.
Analyzing end-of-life care legislation: a social work perspective
- Author:
- ROFF Sherri
- Journal article citation:
- Social Work in Health Care, 33(1), 2002, pp.51-68.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Several policy approaches are currently being considered in an attempt to organise an American national response to the crisis surrounding quality end-of-life care. Recent health care efforts aimed at supporting individuals facing advanced illness are marked by debate over assisted suicide, untimely referrals to hospice care, inconsistent adherence to advance directives, and substantive amounts of unrelieved pain in end-of-life. This article discusses recently proposed policy responses to the various political and social controversies surrounding end-of-life care for individuals facing advanced illness. The analysis will suggest criteria for evaluating end-of-life policy in general and offer a framework for evaluating proposed legislation. Highlights the implications for social work practice.