0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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. doi:10.1001/jama.2009.1871.
Text Size: A A A
Published online

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.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure. Hypothetical Trajectories of Functional Decline for Mr Z
Graphic Jump Location

Possible future functional and health status trajectories for Mr Z. Trajectory A assumes good health and gradual functional decline with Mr Z living twice the median survival of 85-year-old US men. Trajectory B assumes that he develops a chronic degenerative disease (eg, Alzheimer disease, Parkinson disease) and experiences steady functional decline with a period of prolonged functional dependency and the expected length of survival. Trajectory C assumes a sudden catastrophic event (eg, hip fracture, stroke) with some functional improvement but without return to baseline and a shorter than expected life.

Tables

References

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 39

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();