Dignity and palliative care in dementia.

Care for patients with dementia poses multiple challenges to the caretaker, including issues concerning maintaining patient dignity. In this paper, we discuss dignity in the context of patient autonomy, self-respect and appreciation, and explore issues that relate to dignity of patients in dementia care. As patients become incapacitated by the disease, it becomes the caretaker's responsibility to assure that the patient continues to live with dignity. The uniform manifestation of dementia symptoms across individuals allows for implementation of patient-friendly activities to address their special needs and allow them to express the remaining autonomy. In advanced dementia, a beneficial long-term care outcome becomes secondary and should give way to strategies to maintain patient comfort and dignity. Although it may be challenging to stress dignity in a patient with advanced dementia, where multiple serious health problems are likely to co-exist, it remains important to realize that dignity can be, should be and must be supported, maintained and, in some situations, regained.

[Biological mechanisms of aging]. / Biologické mechanizmy stárnutí.

Contemporary views on the mechanisms of aging and aging variations--progeria and longevity are presented. Replicative aging, the roles of glycation and free radicals on the genetical determination of progeria and longevity are discussed.

[Geriatric view on the health and disease in old age--changes in the paradigm?]. / Geriatrický pohled na zdraví a nemocnost ve stárí--zmena paradigmatu?

Article is aimed at the health status of seniors, their prognosis and namely at the conception of health and disease in old age. It calls attention to the paradigm changes that should overcome the predominating concentration on the disease and stress the functional status and the quality of life of the patient. Concepts of geriatric fragility, geriatric deterioration and geriatric syndromes are delimitated. Health potential based on the stamina, vitality and creative adaptability is accepted and its relation to Antonovian concept is given. Conclusion is given to the outlines of necessary systemic changes in the health care of seniors in order to adjust it better to their actual requirements.

Smokers need higher doses of neuroleptic drugs.

There is indirect evidence that smoking induces higher enzymatic activity which accelerates the metabolism of many drugs. This influence is inferred from the frequency and magnitude of drug side effects. We could demonstrate that smokers need higher doses of neuroleptic drugs than nonsmokers.

[Modern trends in gerontology]. / Soucasné trendy v gerontologii.

The paper discusses the main problems in gerontology, geriatrics and care of old persons. It stresses the importance of the geriatric discipline and a new conception of providing health care and social services to persons of high age.

[The phenomenon of rectangularization of the survival curve in the Czech population as a result of the concept of successful aging and geriatric medicine]. / Fenomén rektangularizace krivky prezívání v Ceské populaci jako východisko ke konceptu úspesného stárnutí a k pojetí geriatrické medicíny.

An overview of conceptions of the successful ageing with positive impacts on the improvement of the quality of life, on decreased dependence in activities of daily living, and on demands for health-social care in senescence is given. Necessity of altering of sanitary services and outlooks on the geriatric patients corresponding to the demographic development and improvement of their functional state is stressed. Concepts of the upgrowth of the life expectancy are given. The phenomenon of rectangularization of the survival curve in the population of the Czech Republic during the 20th century is demonstrated and the prospect till the middle of 21st century for the population structure, life expectancy, longevity index are presented.

[Mistreatment, abuse and neglect of senior citizens as a medical problem]. / Týrání, zneuzívání a zanedbávání senioru jako medicínský problém.

The author presents an account of contemporary approaches to the problem of maltreatment, abuse and neglect of senior citizens. He draws attention to risk factors, clinical manifestations and different forms of maltreatment. Briefly basic remedies are discussed. Special attention is devoted to maltreatment and unsuitable treatment in facilities for long-term care.

[The concept of geriatric medicine and differentiated geriatric care]. / K pojetí geriatrické medicíny a diferencované geriatrické péce.

The concept of geriatric medicine as a differentiated care of geriatric patients is discussed. Essential is the conception of a geriatric patient, endangered by specific geriatric risks and profiting from the specific geriatric care and regimen. Within the institutional geriatric elements, methodological issues of the development of the geriatric care namely the acute geriatric hospital wards in and subacute hospital wards are stressed. Significance of paramedic personnel (nurses, occupational therapy) in geriatric care is given and the necessity of follow up and long-term hospital care as well as primary non-medical care and community centers is shown. The potential of the district geriatric nurses employed by community centers parallel to the home care agencies is mentioned.

[Diagnostics and differential diagnostics of dementia from the view of internal medicine--geriatrics: hazards of the false positive diagnose]. / K diagnostice a diferenciální diagnostice demencí z pohledu internisty--geriatra: úskalí falesne pozitivní diagnózy.

Psychosocial consequences and results of diagnosis of dementia are cited, and the risk of false positive misdiagnosis is stressed. We notice importance of multidimensional comprehensive approach and assessment. The list of most important causes of misdiagnosis of dementia as well as of the functional decompensation is presented with special focusing on delirium.

[Primary geriatric care]. / Primární geriatrická péce.

Geriatric patients account for some 60% of the patients who se their health community doctor who thus is also the geriatrician of the first line. According to experience from abroad (Sweden) it is assumed that general practitioners will take over the medical and social care of aged subjects. The authors describe activities associated with this role. They draw attention to the hitherto inadequate collaboration of doctors with the patients' families.

[A specific geriatric regimen. I]. / Specifický geriatrický rezim. I.

The authors discuss the characteristic and justification of a specific geriatric regime, or geriatric departments, and give an account of their experience assembled in tests of this regime under conditions of the geriatric centre of the Third Medical Clinic, Prague, in particular with regard to the general orientation as regards hospitalization of geriatric patients.

[A specific geriatric regimen. II]. / Specifický geriatrický rezim. II.

The authors discuss individual nursing components of the specific geriatric regime. Attention is paid to problems of activation of geriatric patients, cooperation with their families, the system of controlled visits, an individual approach focused on comprehensive solution of the situation in life. Special attention is paid to rationalization of the diagnostic and therapeutic programme with an effort to reduce the administration of tranquillizers.

[The effect of a low-energy protein diet in short-term ambulatory treatment of obese women]. / Ucinnost nízkoenergetické bílkovinné diety v krátkodobém ambulantním podáváni u obézních zen.

Fourteen obese women (BMI 37.2 +/- 7.3) were treated with a very low energy diet containing 1555 kJ (370 kcal) for 14 days. Weight loss occurred in all cases (4.2-10.7 kg, mean 6.46 +/- 1.68 kg), although usual weight-reducing regimens have not succeeded before. There were no complications and results of usual biochemical tests did not change. Body mass index and concentrations of serum total cholesterol decreased significantly, insulin levels fell in the first and fourth hour of a glucose tolerance test. Also serum triiodothyronine concentrations declined significantly but not below the lower limit of normal results. We concluded that short-term very low energy diet treatment enable a safe decline of excessive body mass in out-patients, including those resistant to usual reducing diets.

[Unusual paraneoplastic encephalopathy in a case of bronchogenic carcinoma]. / Méne obvyklá paraneoplastická encefalopatie u prípadu bronchogenního karcinomu.

A case report deals with an observation of a 58 year old woman with small-cell cancer of the lung metastasizing to regional lymph nodes. Quickly and early before any manifestation of the underlying fatal illness a paraneoplastic encephalopathy developed with psychiatric and neurological signs of cerebellar ataxia and secondary epilepsy.

[Results of the large intestine resection in elderly patients]. / Výsledky resekce tlustého streva u nemocných ve vysokém véku.

The colorectal carcinoma incidence increases with age. The radical resection procedure significantly extends the survival period, when compared with other therapeutic approaches. The tissue damage may exceed the organ reserve capacity in cases of the elderly patients and may result in higher postoperative morbidity and mortality rates. The aim of this study was to compare the results and the surgical risks of the large intestine carcinoma resection procedure in elderly patients, compared to younger patients with the same diagnosis. THE PATIENT GROUP AND METHODOLOGY: The retrospective study summons up the clinical results of 3778 patients from all over the Czech Republic, who underwent primeoperations for the following diagnoses: C18--a malignant neoplasm of the large intestine, and C19--a malignant neoplasm of the rectosigmoideal junction, in 2001. The results are compared with our own patient group in the same time-period. The results were assessed according to the following age-group criteria: 21-59 yrs., 60-69 yrs. and over 70 yrs. of age. We assessed the following factors: age, diagnosis, incidence of early postoperative complications and duration of patients hospitalization. RESULTS: The patients in the 21-59 year-group and in the group over 70 years of age, had significantly different rates of early postoperative complications (12.3% vs 17.6%, p < 0.001). The rate of complications was twice as high in urgent procedures compared to planned procedures in all age groups (p < 0.001). The average hospitalization lasted 14.8 +/- 10.9 days. We discovered statistically significant differences in the duration of hospitalization among all three age groups respectively (p < 0.01). CONCLUSION: Based on our results, we believe the age itself not be an indication-limiting factor for the radical resection procedure for the large intestine carcinoma. The elderly patients benefit from its oncological radicality with acceptable rates of the postoperative complications risks. We believe even extensive surgical procedures to be feasible in cases of appropriately indicated elderly patients, and their surgical risks to be acceptable considering the expected benefits for the respective patient.

[Awareness of the political abuse of psychiatry in relation to psychiatry and the law]. / Na co upozornilo politické zneuzívání psychiatrie ve vztahu psychiatrie a práva.

The political abuse of psychiatry in the former USSR was enabled by: 1. a disproportionate pointing up of the medical criteria of mental disorder to the detriment of the social ones, above all by circumventing the sociological labelling process; 2. lack of control of involuntary psychiatric hospitalisation by the law; 3. an obsolete definition of psychiatry. The author suggests a definition of psychiatry taking into consideration both the above mentioned criteria and making the importance of the legal control of involuntary psychiatric hospitalisation more evident.

[Why diagnostic classification in psychiatry?]. / Proc diagnosticky klasifikovat v psychiatrii?

The authors draw attention to doubts regarding diagnostic psychiatric classification and underrating of an accurate terminology, particularly during the last 15 years. They analyze advantages, the purpose and sense of diagnostic classification patterns and expectations from this pattern. They submit arguments for the statement that psychiatric diagnosis is essential for the mutual understanding, for assessment of therapy, prognosis and evaluation and also for psychiatric research.

[Teaching of geriatrics and gerontology at medical schools]. / Výuka geriatrie a gerontologie na lékarských fakultách.

Analysis of goals and approaches in teaching geriatrics and gerontology for undergraduate medical students according to literature and personal 6 years experience. A proposal of "two module model" with introductory module of general gerontology in first years of studium (stress on communication, reflection of the elderly as human beings, their limitations, risks, and needs, lectures for medical students as well as for students of nursing, occupational therapy and so on to support team approach). Advanced module of "proper medical geriatrics" in late clinical years of studium (to stress atypical character of diseases, investigation, differential diagnosis and importance of acute care for elders units).