Elder Self-Neglect - How Can a Physician Help?
New England Journal of Medicine (Impact Factor: 55.87). 12/2013; 369(26):2476-9. DOI: 10.1056/NEJMp1310684
Clinicians often expend considerable effort caring for elderly patients who neglect their own needs. But there are some practical approaches to the clinical care of self-neglecting patients. Mr. L. is a 96-year-old widower with critical aortic stenosis and mild cognitive impairment who had become increasingly short of breath and exhausted over the course of several weeks and needed 3 hours to get dressed on the day of admission. A concerned neighbor brought him to the hospital. He is not a candidate for aortic-valve replacement owing to poor functional status and coexisting conditions, and after several days of gentle diuresis, he can barely walk across the room. At the request of the primary care physician, Mr. L.'s son flies in for a family meeting to discuss discharge options. ...
Article: Staying at Home[Show abstract] [Hide abstract]
ABSTRACT: Home hospice clinicians frequently care for patients who wish to remain in their homes, even when doing so poses a risk to patients’ safety. Through the use of a running case study, this article introduces readers to the concepts of (a) the dignity of risk and (b) accommodation, arguing that such concepts can be used as ethical principles to help guide teams, patients, and family members in developing plans of care for such patients. As regulatory requirements dictate that US hospice nurses coordinate the care of home hospice patients, empowering such nurses to develop the capacity to integrate ethical decision making into their practice and engage their organization’s ethics resources when struggling to balance competing care values supports sound clinical practice.Journal of Hospice and Palliative Nursing 01/2014; 16(4):200-205. DOI:10.1097/NJH.0000000000000058 · 0.44 Impact Factor
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