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Biomedical subjects

J R McCartney

Publications and source records attributed to J R McCartney.

29 records · Page 2Linked to original sources
PubMed1985

Assessment of cognitive deficit in geriatric patients. A study of physician behavior.

A crucial factor in promoting a vigorous quality of life in the aging population is assessment and treatment of cognitive deficits. A very high percentage of delirium and at least 20% of dementia is eminently treatable. This study of patients over 65 years of age admitted to a university general hospital reveals that 79% of cognitive deficits were missed by the examining physicians. Furthermore, in 394 examinations of 165 patients, only four mental status examinations were recorded. A clear-cut cognitive deficit on admission was predictive of later acute episodes of confusion. The global techniques of evaluation deserve remediable action by medical schools and hospital training programs if the medical care of the elderly is to be improved.

Aged↗
PubMed1979

Refusal of treatment: suicide or competent choice.

Increasingly, patients are exercising the right to refuse treatment. Patients who have been chronically ill or those who consider themselves terminally ill are most apt to do so. Accordingly, liaison psychiatrists are asked to determine whether refusal of treatment is an act of suicide or a competent choice. This is difficult to assess in the absence of delirium or overt psychosis. It is suggested that the dynamics and affective tones of the patients' reaction to the health care system as well as to family and friends are of major significance in this determination. The actual process of exploring these areas with patients making this choice is often therapeutic in restoring the patients' sense of control or authenticity. Often this process enables them to continue treatment and avoid the impulsive interpersonal anger that characterized the suicidal act.

Adult↗
PubMedDate not supplied

Elderly women who want to live alone: lessons learned.

Housing programs should be designed to meet the personal and interpersonal needs of the growing number of older people in the population. Our understanding of these needs is based on our understanding of "normal aging," or more appropriately what makes for successful aging. Attention to what is required for that success and for quality of life is essential. It is offered that respect for individuality, autonomy, and control is central to the maintenance of identity and integrity. Attention paid to the positive poles of Erickson's view of identity in the life cycle would serve to reinforce and maintain both identity and the quality of life. Our most difficult patients, elderly women who want to live alone, have much to teach us about the struggle of the elderly to maintain a sense of self.

Activities of Daily Living↗
PubMedDate not supplied

Management of refusal of medical treatment.

As patients increasingly refuse medical and surgical treatment, the physician's response to this challenge to the healing-helping role is often extremely negative. Even though refusal may be felt by the patient as the only way to regain a measure of autonomy or control, such a response may have more to do with characteristic coping styles or interpersonal battles with the physician, staff, or family than with the treatment itself. Since management hinges on understanding the intrapersonal and interpersonal factors which contribute, it is essential to explore the meaning of the refusal. With reduction of the adversarial stance, the patient frequently regains enough sense of self to engage in a mutually cooperative effort. Even if the refusal stands, with understanding, the physician may be able to accept the patient's choice, and extrusion from the system upon which the patient is still dependent is avoided.

Dependency, Psychological↗