David Geffen School of Medicine at UCLA, Department of Medicine, Division of Geriatrics, 10945 Le Conte Ave, Ste 2339, Los Angeles, CA 90095-1687, USA.
JAMA. 2009 Dec 23;302(24):2686-94. doi: 10.1001/jama.2009.1871.
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. 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.
一位 83 岁的男性，曾因跌倒受伤，且仍独自照顾患有痴呆症的妻子，他的情况是临床医生常见的情况——为老年人生命的最后几年做规划。为了能够适当地关注患者最紧迫的问题，这种方法应该从评估预期寿命开始，并尽可能纳入基于证据的护理。短期问题侧重于努力使患者恢复到之前的健康状态。中期问题涉及提供预防保健、识别老年综合征以及帮助患者应对作为照顾者的心理社会需求。长期问题与规划他最终的衰退以及满足他生命末期的目标有关。不幸的是，初级保健实践的工作量和效率低下，成为为老年患者提供最佳护理的障碍。需要系统的方法，包括团队护理，以充分管理慢性疾病并协调护理。
