RESUMO
The care received by nursing home residents with diabetes does not meet ADA standards for ambulatory adults, this study finds. Nor should it. The frail elderly need new standards that address their particular needs.
Assuntos
Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Casas de Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/normas , Glicemia/análise , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/mortalidade , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Gerenciamento Clínico , Feminino , Seguimentos , Idoso Fragilizado , Instituição de Longa Permanência para Idosos/normas , Humanos , Hipoglicemiantes/uso terapêutico , Assistência de Longa Duração/normas , Masculino , Guias de Prática Clínica como Assunto , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Estados UnidosAssuntos
Analgésicos Opioides/uso terapêutico , Atitude do Pessoal de Saúde , Prescrições de Medicamentos/estatística & dados numéricos , Dor/tratamento farmacológico , Dor/epidemiologia , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Recusa em Tratar/estatística & dados numéricos , Região dos Apalaches/epidemiologia , Atitude Frente a Saúde , Doença Crônica , Humanos , Papel do Médico , Relações Médico-Paciente , Projetos Piloto , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Persistent megacolon that results from frequent episodes of fecal impaction without adequate treatment is a rare and seldom reported condition in the elderly. This report discusses a 72-year-old white woman presenting with a large abdominal mass, who had at least 4 episodes of radiographically demonstrated fecal impaction over the previous year without adequate treatment. The patient required hospitalization for a bleeding rectal ulcer during the second episode of fecal impaction. Computed tomography (CT) scans on this admission revealed a dilated colon up to 16 x 14 cm in maximal dimensions extending over 30 cm, filled with massive fecal material. Several follow-up abdominal radiographs revealed a persistent megacolon after 10 months despite the absence of significant fecal material in the rectosigmoid colon. While multiple contributing factors were likely involved in her frequent fecal impactions, the clinical course of this case suggests that frequent fecal impactions without adequate treatment can lead to megacolon in high-risk patients. Clinicians should aggressively treat fecal impaction and monitor the adequacy of treatment with abdominal radiography in order to avoid significant complications. Complications and management of fecal impaction and the pathophysiology of megacolon in the literature are reviewed and discussed.
Assuntos
Impacção Fecal/complicações , Megacolo/etiologia , Proctite/etiologia , Idoso , Constipação Intestinal/complicações , Constipação Intestinal/terapia , Impacção Fecal/diagnóstico , Impacção Fecal/terapia , Feminino , Humanos , Megacolo/diagnóstico , Megacolo/terapia , Proctite/diagnóstico , Proctite/terapia , Recidiva , Resultado do TratamentoRESUMO
People are living longer but are dying with more disabilities, often in nursing homes. Identification of those who are dying needs to be quicker to allow discussion of goals of care and to meet their individual needs at a higher level. Pain is pervasive and undertreated in general, but institutionalized individuals are even at greater risk of receiving inadequate analgesia. Competing goals of providing good-quality palliative care while meeting federal and state expectations of improving or maintaining function can create dilemmas for those caring for terminally ill patients in nursing homes. Physicians play a critical role in improving communication between the family and the healthcare team during the transition from rehabilitative to palliative care. Hospice can be a valuable partner in the delivery of excellent pain and symptom management in end-of-life care.