Biomedical subjects

S Pautex

Publications and source records attributed to S Pautex.

5 recordsLinked to original sources

PubMed2006

[Anxiety in palliative care].

In palliative care, the intensity and duration of anxiety as well as its consequences on the patient's daily activities can significantly decrease his quality of life. Anxiety that does not incapacitate the patient to the point of his being unable to communicate or perform his usual activities does not necessarily require drug treatment. The non pharmacological treatments of anxiety are presented in some detail. Prescription of anxiolytic drugs in renal or hepatic failure, as well as when oral intake or venous access are difficult, is briefly discussed.

Anxiety↗

PubMed2006

[Management of chronic pain in older persons].

Chronic pain is common in older adults and its consequences are often severe. Several studies have demonstrated that pain in older adults is poorly controlled because they underreport pain and caregivers often underestimate patient's pain. Analgesics can be used safely and effectively in this population. Start with the lowest effective dose, monitor frequently on the basis of expected absorption and pharmacokinetics of the drugs and then titrate on the basis of clinically demonstrated effects and the side effects. Other aspects of the management of pain in older persons will be described in the article.

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PubMed2002

[Futility in geriatric medicine, a real issue].

Is futility age related? Several studies clearly demonstrate that outcome in critically ill elderly patients admitted to an intensive care unit, is more closely related to severity of illness than to age, which has little influence on prognosis. The outcome is closely associated with the severity of the illness, and age is of little influence. However, age based discrimination persists despite current recommendations from medical societies that age should not be used as a criteria for admission to intensive care. The concept of medical futility is influenced by individual or collective subjective values. Very old patients often are excluded from studies. It is difficult to apply evidence-based medicine in older people as results must be extrapolated from data in younger subjects. Thus, the true benefit of treatment is difficult to assess in the elderly. The image of the older patient, as perceived by younger health care professionals and society has a considerable impact on medical care. Medical futility is often based on clinical concepts which may lead to legal policies. It is influenced by social and economic factors. Health care professionals have a crucial role but their position, in close proximity to the patient, and its resulting emotional burden can be uncomfortable. In geriatric medicine, there is a special relationship between patients, relatives, and health professionals which requires genuine communication in order to optimise patients case. In conclusion, a balanced approach that avoids both overtreatment and therapeutic nihilism is important in order to provide old patients the best possible care.

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PubMed2000

Sleep disordered breathing in the elderly.

Sleep disordered breathing (SDB), i.e., obstructive, central or mixed sleep apneas, has been recognized as a common occurrence in the elderly. Aging is per se associated with a decrease in the quality of sleep; SDB may further disrupt the sleep architecture in older subjects. The prevalence of obstructive sleep apnea (OSA) increases with aging; available studies report prevalence rates of 11-62%. Furthermore, OSA has been associated with increased mortality in older adults. Central apneas and periodic breathing occur with increased frequency either in subjects with neurological disorders such as infarction, tumor, sequelae of infection, diffuse encephalopathies, or in chronic heart failure. Patients with cerebrovascular disease (stroke, or transient ischemic attacks) have a markedly high prevalence of SDB, mainly OSA. In these patients, SDB is associated with a poorer functional prognosis at 3 and 12 months after the acute event, and a higher mortality. The clinical impact of SDB on cognitive function appears to be modest in patients without dementia, although there is a moderate increase in daytime sleepiness. In Alzheimer's disease (AD) however, SDB occurs more frequently than in non-demented older subjects, and its severity is correlated with the degree of cognitive impairment. The hypothesis of a causal relationship between AD and SDB remains a subject of controversy. The possibility of SDB should be considered in the elderly in the differential diagnosis of "reversible dementias", increased daytime sleepiness, or unexplained right-sided heart failure.

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PubMed2000

[Respiratory sleep disorders in the elderly].

Ageing is often associated with a decrease in the quality of sleep. In older subjects, sleep-related breathing disorders (SRBD) are increasingly recognized as being responsible for alterations in the quality of sleep. The prevalence of obstructive sleep apnea (OSA) increases with ageing; despite sometimes major disturbances in sleep structure, clinical symptoms are often subtle in this age group. Central apnea and periodic breathing, also more frequent in older subjects, most often occur in patients suffering either from neurological problems (such as tumors, brain infarcts, sequelae of infection, diffuse encephalopathies) or moderate to severe heart failure. In fact, patients suffering from cerebro-vascular diseases (such as brain infarcts or transient ischemic attacks) have a higher prevalence of SRBD than a control age-matched population. In these patients, SRBD are associated with a poorer prognosis in terms of functional recovery and survival. The clinical impact of SRBD on cognitive function appears to be modest in patients without dementia, albeit for a slight increase in daytime somnolence. However, in patients suffering from Alzheimer's disease, SRBD occur more frequently than in non-demented subjects, and indexes of severity of SRBD have been correlated with the importance of cognitive impairment. The hypothesis of a causal relationship between SRBD and the degree neuropsychological impairment in either Alzheimer's disease or multi-infarct dementia remains a matter of controversy. SRBD should be considered as a possible cause of "reversible dementia" and sought for in the presence of daytime somnolence, delirium, or unexplained right-sided heart failure in older patients.

Age Distribution↗