Primary care
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Caring for elderly patients and their families at the end of life gives physicians the opportunity to have a meaningful impact on the lives of others. By expanding our clinical expertise beyond the arena of cure and the preservation of life, we can discover new ways to encounter our patients as full human beings and to share a profound life passage that many of us might otherwise ignore. The skills that are needed to enter this new arena are well within the grasp of the office-based clinician, and physicians who employ them are rewarded with the fulfillment of knowing they have provided an invaluable service at a time of greatest need.
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Shared decision making respects patient autonomy and allows patients to select how much they wish to become involved in various health care decisions. Advance care planning allows a person to document preferences that can become operative at a later time when the person has lost decision-making capacity. Structured methods exist for assessing the presence or absence of decision-making capacity, but some subjectivity cannot be eliminated from these assessments. An ethical challenge in the care of older patients who have diminished capacity is to show respect for their previously expressed wishes and for their present, experienced quality of life.
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Only recently has the medical profession focused on the importance of sleep and health. There are increasing numbers of studies linking sleep disorders with neurobehavioral and cardiovascular morbidity and possibly mortality. ⋯ Common presenting symptoms to physicians include hypersomnia and insomnia. A systematic workup helps to diagnose the underlying cause.