Annals of Long Term Care

Overview of the Problem
When one thinks about common causes of morbidity and mortality in elderly, osteoporosis is probably not one of the first conditions to come to mind. Even though most physicians are aware of osteoporosis, it is generally considered a less important health matter. Because elderly patients often have several medical problems, these other diseases often attract the attention of the health care provider; as a result, osteoporosis frequently is not adequately addressed. Yet, osteoporosis is a serious, debilitating ailment with morbidity, mortality, and economic costs

Karen E. Hall, MD, PhD, Assistant Professor at the Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan, Ann Arbor, and Research Scientist, GRECC, at the Ann Arbor VA Medical Center, MI, suggested that esophageal cancer, like colon cancer, may begin with a progression of mutations rather than a single causative event such as acid reflux.  

Current recommendations include that patients with high-grade dysplastic lesions should be referred for endoscopy (to rule out Barrett’s esophagus) and possible surgery.  Dr. Hall feels, however, that patients with m

Introduction

The pain that accompanies surgical procedures is often inadequately treated, can affect the perception of subsequent noxious stimuli, and can lead to more chronic painful conditions. Moreover, existing painful conditions and prior painful experiences, regardless of whether they are the current indication for surgery, can exacerbate the pain that accompanies surgical procedures. As the neurobiology of pain perception becomes better understood and applied clinically, it becomes clear why patients with chronic painful conditions could be at risk for a more intense pain experie

Introduction
Given the “home-like” atmosphere that long-term care facilities are often committed to creating, plus the ideological stance that provision of a rich and meaningful experience entails addressing sexual desires and needs, an array of challenging ethical issues abound.

This article details a specific case scenario involving two residents experiencing different degrees of dementia, wishing to engage in a romantic and possibly sexual relationship. While not exhaustive, a number of ethical issues are raised, specific to the context of long-term care.

Ethical conc

INTRODUCTION

Background
Dying is the final portion of the life cycle for all of us. Providing excellent, humane care to patients near the end of life, when curative means are either no longer possible, or no longer desired by the patient, is an essential part of medicine. The American Geriatrics Society (AGS) recognizes that most people near the end of life want to live as fully as they can. They want their health care providers to honor their wishes and goals and to help them maintain their dignity and independence while relieving symptoms and maximizing comfort. For physicians and heal