Abstract:
OBJECTIVE:To describe the prevalence and content of long-term care facility policies regarding the use of life-sustaining treatments (cardiopulmonary resuscitation (CPR), artificial hydration and nutrition, dialysis, antibiotics for life-threatening infections, transfer to acute care hospital) and advance directives in Canada. DESIGN:Cross-sectional mailed survey. SETTING:Canadian long-term care facilities with 25 beds or more listed in the 1991-92 Directory of Long Term Care Centres in Canada. Institutions listed as, "general hospitals," "psychiatric hospitals," "children's treatment centres," "group homes," or as purely residential facilities were excluded. PARTICIPANTS:Chief Executive Officers or their designates. MAIN OUTCOME MEASURES:Respondents' self-reports regarding the existence of life-sustaining treatment or advance directive policies and content analysis of the policies themselves. RESULTS:Of 1472 long-term care facilities, 1021 (69%) responded. Of these, 344 (34%) institutions had 397 policies regarding the use of life-sustaining treatments or advance directives. Three hundred twenty facilities (31%) had 349 do-not-resuscitate (DNR) policies (40% on CPR alone and 60% on CPR plus other life-sustaining treatments). Seventeen institutions (2%) each had one policy addressing life-sustaining treatments other than CPR, and 31 institutions (3%) each had one policy addressing advance directives. Of the 397 policies, 171 (43%) required routine discussion with all patients, 156 (39%) mentioned futility, 331 (83%) indicated that the competent patient had the right to make a decision about life-sustaining treatment, 265 (67%) indicated that the family of the incompetent patient had this right, 27 policies (7%) mentioned conflict resolution, 378 (95%) had an explicit requirement for recording the decision, 10 (3%) required explicit communication of the decision to the competent patient, 10 (3%) required such communication to the family of the incompetent patient, 260 (66%) required updating of the decision, and 213 (54%) mentioned rescinding or changing the decision. CONCLUSIONS:Only one-third of Canadian long-term care facilities have do-not-resuscitate policies, and even fewer have policies on advance directives or life-sustaining treatments other than CPR. The policies themselves could be improved by encouraging routine advance discussions, scrutinizing the use of the futility standard, stipulating procedures for conflict resolution, and explicitly requiring communication of the decision to competent patients or substitute decision makers of incompetent patients.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Choudhry NK,Ma J,Rasooly I,Singer PAdoi
10.1111/j.1532-5415.1994.tb06980.xsubject
Has Abstractpub_date
1994-11-01 00:00:00pages
1150-3issue
11eissn
0002-8614issn
1532-5415journal_volume
42pub_type
杂志文章abstract::Low-income Latino immigrants are understudied in elder abuse research. Limited English proficiency, economic insecurity, neighborhood seclusion, a tradition of resolving conflicts within the family, and mistrust of authorities may impede survey research and suppress abuse reporting. To overcome these barriers, promoto...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2012.04025.x
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVES:To determine if poorer healthcare and financial decision making forecasts adverse cognitive outcomes in old age. Specifically, we hypothesized that poorer decision making would be associated with an increased risk of incident Alzheimer's dementia, an increased risk of incident mild cognitive impairment (MCI)...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15880
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVES:To determine the feasibility and effect of exercise training after stroke. DESIGN:Randomized exploratory trial comparing exercise training (including progressive endurance and resistance training) with relaxation (attention control). SETTING:Interventions were performed in a rehabilitation hospital. PARTI...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1532-5415.2007.01185.x
更新日期:2007-06-01 00:00:00
abstract::There is accumulating evidence that interactions between beta-amyloid and copper, iron, and zinc are associated with the pathophysiology of Alzheimer's disease (AD). A significant dyshomeostasis of copper, iron, and zinc has been detected, and the mismanagement of these metals induces beta-amyloid precipitation and ne...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1046/j.1532-5415.2003.51368.x
更新日期:2003-08-01 00:00:00
abstract:OBJECTIVES:To determine the effect of milk and dairy intake on the development of all-cause dementia and its subtypes in an elderly Japanese population. DESIGN:Prospective cohort study. SETTING:The Hisayama Study, Japan. PARTICIPANTS:Individuals aged 60 and older without dementia (N = 1,081). MEASUREMENTS:Milk and ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.12887
更新日期:2014-07-01 00:00:00
abstract::Generalist physicians provide most primary care for older people. Increasingly, undergraduate clinical education occurs in community sites. Hence, community-based generalist faculty members need continuing education in geriatrics to support clinical practice and teaching. The Geriatrics Scholars Program provided conti...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2007.01050.x
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVES:Many elderly persons have drug benefits with coverage gaps, such as in Medicare Part D. Because beneficiaries who have such gaps must pay all drug costs, an accurate knowledge of gap thresholds and communication with providers about exceeding caps is important for elderly persons to manage out-of-pocket drug...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2009.02244.x
更新日期:2009-05-01 00:00:00
abstract::Hyponatremia, the most common electrolyte disorder, occurs frequently in older people and in hospitalized patients. Physiological changes of aging that interact with diseases and drugs commonly present in older people put this population at greater risk for hyponatremia. It can accompany central nervous system disorde...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.2005.00609.x
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVES:To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10-year trajectories of incident disability for cognitively intact participants and subgroups with MCI. DESIGN:Prospective cohort; 10 years of follow...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53566.x
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVES:To describe the effect of age on psychotropic coprescribing, psychiatric diagnoses, and other clinical characteristics. DESIGN:Analysis of the National Ambulatory Medical Care Survey. SETTING:A national sample of outpatient visits to physicians (N = 2,406) in office-based practice in 2010. PARTICIPANTS:Ad...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/jgs.12640
更新日期:2014-02-01 00:00:00
abstract::Case examples of doctor-patient interactions are used to examine educational strategies employed by physicians to obtain compliance with medication regimens from elderly patients. The problems addressed by the physicians included the complexities of pharmaco-therapy in the elderly (the patients each presented multiple...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1984.tb06138.x
更新日期:1984-08-01 00:00:00
abstract::Cognitive impairment in old age is one of the most important topics in modern geriatrics. This article discusses the historical dimensions of this phenomenon. To this end, a number of primary sources ranging from antiquity to the modern era are evaluated. Although a physiology and pathology of old age were conceptuali...
journal_title:Journal of the American Geriatrics Society
pub_type: 历史文章,杂志文章
doi:10.1111/j.1532-5415.2005.53558.x
更新日期:2005-11-01 00:00:00
abstract::The objectives of this study were to review the diagnostic, International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM), diagnosis related groups (DRGs), and common procedural terminology (CPT) coding and reimbursement issues (including Medicare Part B reimbursement for physicians) encounte...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1046/j.1532-5415.2002.50519.x
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVES:To compare the risk of congestive heart failure (CHF) in elderly individuals treated with any peripheral alpha-1 antagonist for hypertension with any thiazide, test whether the risk persists in subjects without cardiovascular disease (CVD) at baseline, and examine CHF risk in normotensive men with prostatism...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2004.52456.x
更新日期:2004-10-01 00:00:00
abstract:OBJECTIVE:To develop and validate the Physical Performance and Mobility Examination (PPME), an observer-administered, performance-based instrument assessing 6 domains of physical functioning and mobility for hospitalized elderly. DESIGN:Development of a pass-fail and 3-level scoring system and training manuals for the...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1994.tb06535.x
更新日期:1994-07-01 00:00:00
abstract::The stage of a cancer at diagnosis is multiply determined, theoretically depending on such disparate factors as tumor biology, patient education, and physician behaviors. Data from all Hispanic and non-Hispanic white residents of New Mexico diagnosed with a malignancy from 1969 through 1982 were analyzed to determine ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1986.tb06335.x
更新日期:1986-01-01 00:00:00
abstract:OBJECTIVES:To examine the effects of caring for a spouse with dementia on the caregiver's risk for incident dementia. DESIGN:Population-based study of incident dementia in spouses of persons with dementia. SETTING:Rural county in northern Utah. PARTICIPANTS:Two thousand four hundred forty-two subjects (1,221 married...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.02806.x
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVES:To determine if aging modifies the clinical presentation of hyperthyroidism and the signs of thyrotoxicosis in older people. DESIGN:Prospective cohort study. SETTING:A French university hospital. SUBJECTS:Eighty-four new patients with overt hyperthyroidism confirmed chemically between January 1992 and Jan...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1996.tb05637.x
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:To determine whether older people who use nonsteroidal anti-inflammatory agents (NSAIDs) have increased levels of blood urea nitrogen (BUN), serum creatinine, and BUN:serum creatinine ratio. DESIGN:Cross-sectional, secondary data analysis. SETTING:Older people living in the communities of East Boston, MA, N...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1999.tb02561.x
更新日期:1999-05-01 00:00:00
abstract::The elderly take more drugs than the young, and are therefore more susceptible to adverse drug interactions. Prescribing the minimum number of agents is recommended. Drug absorption, metabolism, and excretion may be altered by various interactions. Dose-response relationships of oral anticoagulants, oral hypoglycemics...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1982.tb01358.x
更新日期:1982-11-01 00:00:00
abstract::Available strategies to increase influenza vaccination rates in the elderly have not been tested in the private sector where most elderly receive care. We performed a randomized controlled trial of a postcard reminder in the three private general internal medicine practices. The observed vaccination rates of 55% in ex...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1532-5415.1987.tb06354.x
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVES:To determine whether older adults with mild cognitive impairment (MCI), a condition not previously explored as a risk factor, have more hospitalizations and 30-day readmissions than those with normal cognition. DESIGN:Post hoc analysis of prospectively gathered data on incident hospitalization and readmissi...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/jgs.13593
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Coffee and tea are two of the most widely consumed beverages worldwide and have been associated with reduced risk of mortality in some studies. However, it is unknown whether consumption of these beverages is associated with survival to an advanced age. OBJECTIVE:To examine associations of coffee and tea co...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16467
更新日期:2020-09-01 00:00:00
abstract::Caregiving can have a profound effect on the health of the caregiver, yet research on caregiving among American Indians is limited. The purpose of this study was to examine the influence of caregiving on the health-related quality of life (HRQoL) of American Indians enrolled in the Education And Research Towards Healt...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.12409
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVES:To assess the feasibility of a vitamin D intervention delivered through a Meals-on-Wheels (MOW) program to improve 25-hydroxyvitamin D (25(OH)D) concentrations and reduce falls in homebound older adults. DESIGN:Single-blind, cluster randomized trial. SETTING:MOW, Forsyth County, North Carolina. PARTICIPAN...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,随机对照试验
doi:10.1111/jgs.13610
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:To compare the risk of serious hypoglycemia associated with the use of individual sulfonylureas in older people. DESIGN:A retrospective cohort study. SETTING:The Tennessee Medicaid Program. PATIENTS:A total of 13,963 Medicaid enrollees, aged 65 years or older, who were prescribed one of six sulfonylureas f...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1996.tb03729.x
更新日期:1996-07-01 00:00:00
abstract:OBJECTIVES:To assess the feasibility of cognitive screening in older veterans presenting for routine primary care. DESIGN:Quality improvement initiative. SETTING:Seven Veterans Affairs Medical Centers. PARTICIPANTS:Veterans aged 70 and older without a prior diagnosis of cognitive impairment. MEASUREMENTS:Scores fro...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1532-5415.2010.03249.x
更新日期:2011-02-01 00:00:00
abstract::The necessity and safety of an oral calcium (Ca) and vitamin D regimen was evaluated in a population of 66 independently living and 73 institutionalized elderly women over an 11-week winter period. The members of both groups were randomly assigned into trial and control groups. Serum Ca, creatinine, and calcidiol leve...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1532-5415.1990.tb05700.x
更新日期:1990-08-01 00:00:00
abstract:OBJECTIVE:To investigate the accuracy of cranial computerized tomography (CT) scans in distinguishing patients with Alzheimer's disease from those with other dementing conditions. DESIGN:Retrospective clinicopathological correlation with pre-mortem CT scans. SETTING:Urban and rural hospitals and nursing homes in the ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1992.tb02014.x
更新日期:1992-05-01 00:00:00
abstract:OBJECTIVES:To describe the types of continence aids that older adults hospitalized in acute medical units use and to test the association between use of continence aids and development of new urinary incontinence (UI) at discharge. DESIGN:Prospective cohort study. SETTING:A 900-bed teaching hospital in Israel. PARTI...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2011.03413.x
更新日期:2011-06-01 00:00:00