门诊老年医学实践中的姑息治疗

Palliative care in the ambulatory geriatric practice.

作者信息

Finucane Thomas E, Nirmalasari Olivia, Graham Antonio

机构信息

Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Beacham Ambulatory Care Clinic, Johns Hopkins Bayview Medical Center, 5505 Hopkins Bayview Circle, John R. Burton Pavilion, Baltimore, MD 21224, USA.

出版信息

Clin Geriatr Med. 2015 May;31(2):193-206. doi: 10.1016/j.cger.2015.01.008. Epub 2015 Feb 20.

DOI:10.1016/j.cger.2015.01.008

PMID:25920055

Abstract

Geriatrics and palliative care often overlap. This article focuses on 2 areas where the disciplines may differ in their approach. The first is planning for extreme illness and death, with explicit acknowledgment that limiting therapy might be a good idea. This situation is likely to have a different impact in the course of a routine geriatrics visit than in a palliative care context. The second is pain management, especially chronic pain. In patients with sharply limited life expectancy, the risk/benefit equation tilts easily toward narcotic use. In frail elders working to remain independent, the calculus may be quite different.

摘要

老年医学与姑息治疗常常相互重叠。本文聚焦于这两个学科在方法上可能存在差异的两个领域。第一个领域是针对重病和死亡的规划，明确承认限制治疗可能是个好主意。这种情况在常规老年医学诊疗过程中可能产生的影响与在姑息治疗环境中有所不同。第二个领域是疼痛管理，尤其是慢性疼痛。在预期寿命大幅受限的患者中，风险/收益权衡很容易倾向于使用麻醉药品。而在努力保持独立的体弱老年人中，考量可能会大不相同。