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artificial nutrition and hydration

Anticipatory Conversations: Is there a connection to Ice Cream?

Anticipatory Conversations: Is there a connection to Ice Cream?

Teaser: 

Michael Gordon, MD, MSc, FRCPC,

Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Advance care planning has become a much touted and potentially very important addition to the new operative structure of meeting the many challenges of an ever increasingly older population. From what used to be discussions about CPR and DNR the process has evolved into what many expect might become the basis of end-of-life decision-making that may assist family members and health care providers to meet the needs, wishes and priorities of the elderly population, particularly when they are nearing that last trajectory of life.
Key Words: Artificial nutrition and hydration, advance care planning, living wills, end-of-life planning.
1. Planning before there is a medical crises can help avoid medical decisions that may not be in keeping with your wishes and values.
2. Artificial nutrition and hydration may not be what you really want, even though in its simplest form it may seem desirable as a way of avoiding death.
Communication with those who will be responsible for decision-making when you are no longer able to do so is key to having your end-of-life wishes fulfilled and should not be left to crises situations.
If you have favorite foods, make sure your substitute decision-makers know about them so that when the time comes you will not be deprived of your most enjoyed foods, because some health care provider deems them to be "unhealthy" or not in keeping with an "optimal diet".
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Radiation Therapy in Older Adults

Radiation Therapy in Older Adults

Teaser: 

Loren K. Mell, MD, Department of Radiation and Cellular Oncology, University of Chicago and the University of Illinois at Chicago, Chicago, IL, USA.

Arno J. Mundt, MD,
Department of Radiation and Cellular Oncology, University of Chicago and the University of Illinois at Chicago, Chicago, IL, USA.

Radiation therapy (RT) is commonly used in the treatment of older cancer patients. RT may be used as definitive therapy for benign or malignant tumours, as adjuvant therapy with surgery and/or chemotherapy, as palliative therapy when cure is no longer possible, and as alternative to surgery in patients with multiple comorbidities. However, RT is often not given to older patients who might benefit from it, due to biases, misapprehensions about potential toxicity, and social factors particular to this patient population. The preponderance of data suggest that RT is well tolerated in older adults and treatment decisions should be based on prognostic factors irrespective of age. Emerging RT technologies may particularly benefit aged patients by reducing potential toxicities, shortening treatment times, and improving tumour control.

Key words: age, radiation therapy, toxicity, cancer, procedures.

Artificial Nutrition and Hydration in the Management of End-Stage Dementias

Artificial Nutrition and Hydration in the Management of End-Stage Dementias

Teaser: 

Rory Fisher, MB, FRCP(Ed)(C), Professor Emeritus, Department of Medicine, University of Toronto, Toronto, ON.

Eoin Connolly, MA, Clinical Ethics Fellow, Joint Centre for Bioethics, University of Toronto, Toronto, ON.

Canada's aging population makes appropriate end-of-life care a priority. Alzheimer's disease and related dementias become increasingly common with aging. The terminal stages are characterized by severe cognitive and physical incapacity with a poor prognosis. Artificial nutrition and hydration may be provided by feeding tubes; however, there is no
evidence of benefit, and there are significant side effects to be considered. Barriers to appropriate end-of-life decision making are identified, and current evidence indicates that this patient population should be treated with appropriate palliative care.

Key words:
Alzheimer’s disease, artificial nutrition and hydration, dementia, end-of-life care, ethics.