Clinics in geriatric medicine
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Elderly people in the United States often receive treatment through an enormous array of medical technology when they become critically ill. Some, or all, such interventions may be unwanted, and patients have the right to be informed about what prospects lie ahead. CPR, with survival rates of 2% to 20%, rarely has the effect for which it was intended, as studies over the last two decades have repeatedly demonstrated. ⋯ This is unfortunate, because both surrogates and physicians are poor judges of patients' resuscitation preferences. Advance directives, especially when coupled with effective physician-patient communication, will aid elderly persons in making decisions about life support. We encourage all physicians who care for the elderly to avert many of tomorrow's ethical dilemmas by communicating with their healthy patients today.
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Clin. Geriatr. Med. · Feb 1994
Review Comparative StudyNutritional support of the elderly patient in an intensive care unit.
Critically ill elderly patients are at high risk to develop protein-energy malnutrition as well as micronutrient deficiencies. They have characteristic metabolic alterations which must be understood in order to provide nutritional support. Current nutritional status can be assessed by clinical and laboratory parameters. The enteral and parenteral routes of administering nutrition and their advantages, disadvantages, complications, and monitoring are discussed.
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Certain endocrinologic disorders occur more frequently in the elderly than in younger patients. With the steady increase in the elderly population, acute endocrinologic disorders have become more common. Characteristics of elderly patients, such as diminished homeostatic reserve, increased medication use, and the presence of other diseases allow the transformation of symptoms into medical emergencies.
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Elderly populations are prone to both hyperthermia and hypothermia because of innate physiologic changes associated with aging, the presence of chronic disease, and the use of polypharmacy. Hyperthermia is a true medical emergency with a high mortality rate, requiring rapid cooling and aggressive supportive care. ⋯ Patients should be warmed in the least aggressive manner that will adequately treat their clinical situation. Hypothermia due to underlying disease carries a high mortality rate, as does the onset of ventricular fibrillation.
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Clin. Geriatr. Med. · Feb 1994
ReviewApproach to ischemic heart disease, coronary care, and severe heart failure (including cardiogenic shock).
Elderly patients with cardiovascular disease require slightly different management strategies compared with younger patients. Diagnosis is more difficult. ⋯ Decisions regarding these therapies are based on an incomplete data base and an understanding of the patients' needs. A review of the available data on cardiac surgery, angioplasty, myocardial infarction, and heart failure in the elderly is presented.