Advancing Advance Directives
- Wed, 1/20/10 - 10:47am
- 0 Comments
- 1188 reads
To the Editor,
I just read with interest the article “Advancing Advance Directives” by Dr. Richard Stefanacci.1 I was somewhat surprised that the tone of the article seemed to be about reinventing the wheel. I have spent the better part of three decades in the healthcare arena as a licensed social worker, and we are a tool that is used in many areas to inform, educate, and, in many cases, help execute documents needed for advance planning on end-of-life issues.
While the physicians are already overtaxed with current tasks, I have a hard time reconciling why one more task that can be
Do-Not-Resuscitate Orders: When Is a “No” a “No”?
- Fri, 11/7/08 - 2:42pm
- 0 Comments
- 1609 reads
To the Editor:
I read with interest your article in Clinical Geriatrics.1 I am a nephrologist at a suburban Philadelphia hospital, and I also chair the Ethics Committee. My question concerns an 82-year-old woman with chronic renal failure who for two years had refused dialysis and, in fact, told me not to mention the “D” [dialysis] word when she came for office visits. This woman had been a nurse and knew patients on dialysis, which I think influenced her thinking. Also, she had never told her family that she was seeing a nephrologist. She eventually became uremic, and in
An Elderly Male Found Malnourished and Dehydrated: When Healthcare Systems Fail
- Tue, 3/4/08 - 2:28pm
- 0 Comments
- 534 reads
To the Editor:
This article1 was quite odd. Its title suggests the author will show an example of a “healthcare system” failing to provide necessary services. Instead, we see how ridiculous it can be to attempt to maintain independence at all costs. The 62-year-old man does not even live in the same state as his father, who had had a severe stroke. He was concerned enough to arrange home care, but could
November 2007
- Thu, 1/17/08 - 4:18am
- 0 Comments
- 1119 reads
Using C-Reactive Protein to Predict Cardiovascular Risk
To The Editor:
Dr. Blaine presented an excellent analysis of C-reactive protein usage in the elderly population for cardiovascular risk reduction.1 My question concerns the myeloperoxidase level and its assessment. Should this level be checked, and under what circumstances would it prove useful?
(Dr.) Frank M. Shanley, PA, FACC
Denville, NJ
Reference
1. Blaine JM. Using C-reactive protein to predict cardiovascular risk in older patients. Clinical Geriatrics 2007;15(8):20-25.
________
The Elderly Concentration Camp Survivor
- Thu, 1/17/08 - 4:18am
- 0 Comments
- 872 reads
To the Editor:
Thank you for the excellent article, “The Elderly Concentration Camp Survivor,”1 which highlights a very important aspect of the life of the Holocaust/concentration camp survivor.
While it is true that almost 11,000,000 persons perished as a result of the Nazi regime, not all of the victims were in the camps. Some were murdered while hidden, others tried to resist in the woods, and others were victimized in their homes, streets, and communities. All survivors exhibit needs, as do the camp survivors.
As a final point, for the mental health of the survivors, i
Osteoporosis in Elderly Men
- Thu, 1/17/08 - 4:18am
- 0 Comments
- 957 reads
To the Editor:
I read with interest the article, “Osteoporosis in Elderly Men,”1 written by Neil Baum, MD. The initial background information is pertinent and raises awareness of the growing problem of osteoporosis in men, and a number of preventive and management strategies are suggested. The case presented in the article is a 66-year-old man with a history of prostate cancer that was initially treated with radiation therapy. After a recurrence of cancer, he was treated with luteinizing hormone-releasing hormone agonist and anti-androgen therapy, which is an important risk factor
Caffeine-Induced Symptoms in Patients
- Thu, 1/17/08 - 4:18am
- 0 Comments
- 1006 reads
To the Editor:
I was delighted to see your Psychiatry Rounds article, “Anxiety, Headaches, Insomnia, Restless Legs, and Hypertension: Multiple Disorders or One Problem?”1 I have long recognized a TRIAD: anxiety, restless legs syndrome (RLS), and labile hypertension. As a psychiatrist, I use small doses of clonazepam in these persons to treat three disorders with one drug. I have never before seen “my TRIAD” in print.
I suspect that a deficiency of cytochrome P4501A2, known to be a factor in anxiety, is the cause. Deficient individuals metabolize methylxanthines* at 2 perce
Assessing Capacity in the Older Patient
- Thu, 1/17/08 - 4:17am
- 0 Comments
- 1571 reads
To the Editor:
Thank you for your Psychiatry Rounds column in Clinical Geriatrics—always thoughtful and thought-provoking. I was especially interested in “Decision-Making Capacity.”1 You made many of the same points as Ganzini et al,2 which are increasingly important to be understood by all practitioners caring for elderly and care-dependent patients.
I would like to ask the following:
1. While the law “presumes legal competence” unless adjudicated otherwise, should clinicians presume clinical capacity in settings with a known prevalence of incapacity exceeding 50%,3 such as
The MacCAT-T for Evaluation of Decision-Making Capacity
- Thu, 1/17/08 - 4:17am
- 0 Comments
- 2028 reads
To the Editor:
I thoroughly enjoyed the Psychiatry Rounds article “Decision-Making Capacity.”1 I would like to ask the following:
1. Do you personally use the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) (I was thinking of purchasing the interview for our use), or do you prefer another assessment tool?
2. Generally, in what instances, if any, do you feel that the MacCAT-T is not sufficient and neuro-psychiatric testing is warranted?
Thank you,
Paula Bordelon, DO
Geriatric Fellow
Family Practice
Sacred Heart Hospital
Allentown, PA
REFERENCE
1. Lan
