Geriatrics
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One of the most important components of a peaceful death is adequate control of pain and other distressing symptoms, such as dyspnea, agitation, and restlessness. Pain is an important symptom in 75 to 80% of noncancer patients in the last year of life. ⋯ A sizeable minority of physicians receive requests for an assisted death, which should be seen as a cry for help. The most useful function of advance directives is that they open an avenue for discussion between the doctor and the patient about a difficult subject.
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Palliative medicine describes the care of patients with advanced disease. When cure is no longer possible, the goal becomes control of pain, other symptoms, and psychological distress. ⋯ Palliative care is also appropriate for patients with many of the chronic diseases of aging. For medical, humanitarian, financial, and legal reasons, physicians are being called on to provide palliative care when they make the diagnosis of all illness that is unresponsive to curative treatment.
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Syncope is a sudden and temporary loss of consciousness not caused by trauma or seizures. Patients age 65 and older are at elevated risk of syncope-related falls and sudden cardiac death. ⋯ Many causes of syncope can be diagnosed from a thorough history and physical exam. More extensive testing--ECG, Holter monitoring, electrophysiology study--may be indicated for selected patients with unexplained syncope and an unremarkable evaluation.