Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · Sep 2005
Determinants of the subjective functional outcome of total joint arthroplasty.
The aim of the study is three-fold: (i) to analyze association between early subjective functional outcome of total joint arthroplasty (TJA) and patient-related risk factors; (ii) to evaluate the six-month subjective functional outcome of TJA as compared with subjective functional status of non-operated outpatients; (iii) to evaluate TJA self-perceived amelioration rates compared to the status of an age-matched sample from a general medical practice. A prospective consecutive study was performed upon 100 elderly inpatients with recent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) for osteoarthritis. Interviews on preoperative status and short-term outcome were performed at admission and six months after surgical intervention with Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC). ⋯ Objective functional outcome of post-operative rehabilitation has not revealed predictive value for the six-month outcome of TJA in terms of self-perceived functional status. Logistic regression analysis indicated that preoperative status was the only significant predictor of higher WOMAC scores six months after TJA. The survey confirms the early benefit of THA or TKA for osteoarthritis, but a less favorable subjective functional outcome is expected at six months when preoperative subjective functional status is severely compromised.
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Arch Gerontol Geriatr · Sep 2005
The problem with advance directives: maybe it is the medium, not the message.
Some of today's most significant bioethical challenges center around decisions to initiate or withhold medical treatment for incapacitated patients. In order to ascertain what treatment the patient would have desired, physicians often rely on written advance directives and designated surrogate decision-makers. Unfortunately, both approaches suffer from numerous shortcomings that ultimately limit their usefulness. ⋯ VADs may thus enhance the physician's understanding of the patient's wishes. VADs may also ease family conflict and save physician's considerable time by helping family members reach a stronger consensus on the patient's wishes, and do so in a timelier manner. This article reviews the limitations of written advance directives and surrogate decision-makers and describes why VADs may be helpful in overcoming these limitations.