Fin de vie des patients déments: aspects éthiques
Revue médicale de Bruxelles 2010 Sep; 31(4): 333-41
Most people in contemporary western society die of the chronic diseases of old age. Whilst palliative care is appropriate for elderly patients with chronic, non-malignant disease, few of these patients access such care compared with cancer patients. That patients dying with dementia have significant health care needs, comparable with cancer patients, is now well established. Yet, their families typically describe poor advance-care planning and an inadequate level of symptom control, with distress associated with pain, pressure sores, constipation, restlessness and shortness of breath. A comparison of people dying with advanced dementia or terminal cancer found that those with dementia were more likely to experience burdensome interventions and restraints and to have had poor advance-care planning. Prognostic models that attempt to estimate survival of >6 months in demented patients have generally poor discrimination, reflecting the unpredictable nature of most nonmalignant disease. However, a number of generic and disease-specific predictor variables were identified that may help clinicians identify older, non-cancer patients with poor prognoses and palliative care needs. Simple, well-validated prognostic models that provide clinicians with objective measures of palliative status in demented patients are needed. Additionally, research that analyses the effect of comprehensive geriatric assessment and geriatric palliative care on psychosocial outcomes in demented patients and their caregivers is needed. Advances care planning and directives making before death allow meeting patient's preferences.
Showing items related by title, author, creator and subject.
Le vote des sujets ayant des altérations des fonctions cognitives : aspects législatifs et éthiques Bosquet, Antoine; Medjkane, Amar; Vinceneux, Philippe; Mahé, Isabelle (2010-03)In democratic countries, cognitively impaired persons are a substantial and growing group of citizens. Most of them are citizens with dementia. In dementia, cognitive impairment induces a loss of some capacities, resulting ...
Questions éthiques soulevées par les deux types de protocoles de prélèvements d'organes? coeur arrêt? : aspects particuliers? la France, l'Espagne et aux Etats-Unis Tortosa, Jean-Christophe; Rodríguez-Arias Vailhen, David; Moutel, Grégoire (2010-02)France, Spain and US are three leader countries in activity of organ procurement and transplantation. Donation after cardiac death is one of the strategies they have been implemented in order to face organ shortage. Donation ...