December 30, 2009

USA: Medical Care for the Final Years of Life

. CHICAGO, Illinois / Journal of American Medical Association / December 30, 2009 Care of the Aging Patient: From Evidence to Action CLINICIAN'S CORNER Medical Care for the Final Years of Life "When You're 83, It's Not Going to Be 20 Years" David B. Reuben, MD JAMA. 2009;302(24):2686-2694. ABSTRACT The case of an 83-year-old man who has had a fall-related injury and continues to be the sole caregiver for his wife who has dementia exemplifies a common situation that clinicians face—planning for the final years of an elderly individual's life. To appropriately focus on the patient's most pressing issues, the approach should begin with an assessment of life expectancy and incorporation of evidence-based care whenever possible. Photo credit: Aging Parents Short-term issues are focused on efforts to restore the patient to his previous state of health. Mid-range issues address providing preventive care, identifying geriatric syndromes, and helping him cope with the psychosocial needs of being a caregiver. Long-term issues relate to planning for his eventual decline and meeting his goals for the end of life. Unfortunately, the workload and inefficiencies of primary care practice present barriers to providing optimal care for older patients. Systematic approaches, including team care, are needed to adequately manage chronic diseases and coordinate care. [rc] Author Affiliations: Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California. © 2009 American Medical Association