By R. Sean Morrison, Diane E. Meier, Carol Capello

Geriatric Palliative Care covers a extensive spectrum of matters characterizing care close to the top of lifestyles for older adults. starting with the social and cultural context of previous age and frailty, this quantity info particular facets of palliative care correct to specific issues (e.g. melanoma, strokes, dementia, etc.) in addition to person signs (e.g., ache, fatigue, anxiousness, etc.). communique among care-givers and sufferers, in quite a few settings, is additionally discussed.The subject matter of this ebook is that palliative care is the simplest method of the care of chronically in poor health and frail aged as a result of its specialize in: caliber of existence; aid for practical independence; and the centrality of the patient's values and studies in making a choice on the pursuits of treatment. certainly, Geriatric Palliative Care offers a finished scientific reference for all clinicians who deal with older adults.

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Oregonian 29 September 1997, sec A1, pp. A18–A20. 26. Hoover-Barnett E. POLST form offers choices in care options for dying. Oregonian 2 September, 1998, see D1, p. D13. 27. Hoover-Barnett E. Doctor’s orders. For 10 years, dying Oregonians have had a way to make their wishes heeded. Oregonian 24 October, 2001, sec D1, p. D4. 28. Teno JM, Licks S, Lynn J, Wenger N, Connors AF, et al. Do advance directives provide instructions that direct care? J Am Geriatr Soc 45:508–512, 1997. 29. Tolle SW, Rosenfeld AG, Tilden VP, Park BA.

4 What is the time frame for the imposing reality of severe chronic and/or terminal illness? Questions arise concerning the depth of the inner life at the end of life. How profoundly is an individual coping with the end of life? Is there insight, denial, counterphobia, acceptance? How much does reality motivate a dying person to come to terms with life, reconcile strained relationships, atone for misdeeds? The wonderful play Wit, by Margaret Edson, about a poetry professor who is dying, informs us of the use of intellectual defenses and irony when confronted with death.

The emphasis on system may be key: once decisions limiting life-sustaining treatment have been made, a system is needed to assure that they are understandable, transportable, and respected in a time of crisis. Families are increasingly ready to engage in the dialogue, but the tools of traditional advance directives alone do not meet this need. 28 Can descriptive statistics regarding variation help other communities achieve systems of end-of-life care? edu/dying/factsondying/ht m). Descriptive statistics can focus the energy of a coalition, educate the public via the media, and provide benchmarks for evaluating care.

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