living your best to the end

A new medical decision PATH for the frail elderly

Palliative and Therapeutic Harmonization: PATH In plain language PATH means an assessment and treatment recommendation that takes into account what’s going on with us as a whole person, rather than our specific parts.  A worthy goal for all of us, but with particular importance for those both elderly and frail, and who may have a dollop or more of confusion. Dr Laurie Mallery Dr Paige Moorhouse Dr. Laurie Mallery, head of the Division of Geriatric Medicine at Dalhousie University and Director of the Centre for Health Care of the Elderly at the QEII Health Sciences Centre in Halifax, Nova Scotia. and DrPaige Moorhouse with her Masters in Public Health, also practicing at the QEII, are like-minded in their concerns for care of the frail elderly. Together,  these two good doctors took the initiative to research and develop a  framework for medical decisions related to the frail elderly. The result is PATH: Palliative and Therapeutic Harmonization. Says Mallery: “We spent many years, looking at all factors related to the frail elderly.  Drs Mallery and Moorhouse  practice and teach at the PATH CLINIC . The approach has three parts: 1. Understanding “The frail elderly are often in and out and in and out of healthcare with many crises, assessed by many people – each of whom brings their own lens. There’s no  organizational plan to take this info and use it collectively and understand the significance, for example: is this person near end of life, and should we take that into account in discussing a medical procedure. Sometimes the patient seems frail but they really have a hearing impairment. 2. Clarity of Language “For those...

Cardiopulmonary resuscitation (CPR) in elderly: low survival

Study of In-Hospital Cardiopulmonary Resuscitation (CPR) in the Elderly : Cardiopulmonary resuscitation (CPR) evolved from a specific intervention applied in limited clinical situations to the default response to cardiac arrest in or out of the hospital, an evolution accompanied by a dramatic decline in survival rates after CPR.1-3 The largest study to date, which included 14,720 CPR events from the National Registry of CardioPulmonary Resuscitation, showed that 17% of patients survived to discharge.9 Associations between age and survival after CPR remain unclear, with conflicting results from previous studies.6,10,11 Black race may be associated with lower survival after in-hospital or out-of-hospital CPR and may be associated with delayed defibrillation.12-14 Subsequently, innovations allowing rapid out-of-hospital CPR resulted in improved outcomes in the out-of-hospital setting.4,5 However, it is unclear whether advances in CPR or in care after cardiac arrest have improved outcomes after in-hospital arrest. Full article New England Journal of...