Clinics in geriatric medicine
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Hospice care developed in part as a reaction to the impersonal and technology-dependent end-of-life care offered by modern medicine. Unique approaches to care that emphasize interdisciplinary team management of troublesome symptoms and the promotion of quality of life as defined by the patient, are finding their way into all aspects of health care. Symptom control measures have expanded to include chemotherapy, radiation therapy, and multimodal therapies. Both the development of a unique knowledge base and advances in research have fostered the integration of hospice and palliative care into mainstream medicine.
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Injuries, particularly fractures, are the most serious and costly consequence of falling for older people living in the community. Rather than having a single cause, fall injuries are the result of a combination of intrinsic, situational, and environmental factors. In this article, the epidemiology of fall injuries is reviewed, the results of observational and intervention studies are discussed, and a multifactorial approach to reducing injurious falls is presented.
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Much is known about opioid metabolism, which is critical in administering these agents to the elderly. Fear of addiction and tolerance are the major barriers to their use among patients as well as health-care professionals. Addressing these issues early in the initiation opioid therapy will help to alleviate these concerns. ⋯ It is anticipated that a variety of newly formulated opioids will shortly be available for clinical use. Finally, as a better understanding of the neurophysiology of pain is gained, the clinician can anticipate having more analgesic opioids that target their receptors without agonist or antagonist effect on other opioid receptors. This will allow the clinician to better relieve pain with a minimum of unwanted side effects.
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Clin. Geriatr. Med. · Aug 1996
ReviewAnalgesic drugs for neuropathic and sympathetically maintained pain.
A variety of pharmacologic approaches to the management of pain due to nerve damage have been tried, with mixed results. Sympathetically maintained pain responds most commonly to sympathetic nerve blocks. Oral nifedipine may be a useful adjunct. ⋯ Careful attention to medical, pharmacologic, psychologic, and physical factors are the hallmarks of this type of treatment. The drugs now available provide marked relief to the majority of patients when therapy includes careful attention to the various dimensions of the pain syndrome. Although consistently effective drug therapy for all neuropathic and sympathetically maintained pain is not yet available, the probability of new NMDA antagonists being introduced in the next few years offers promise.
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1. Prevent predictable pain, such as occurs postoperatively. Anticipatory pain management is particularly important in the elderly, who frequently attempt to "tough it out" without much analgesia. 2. ⋯ Unless the patient has a contraindication or there is a strong concern about hemostasis or peptic ulceration, NSAIDs should generally be administered. The major concern in frail elders is acute renal failure; therefore, ensure good hydration and avoid use of NSAIDs if renal function is diminished. NSAIDs should be used on a scheduled (not prn) basis.