Psychologic disorder and sexual dysfunction in elders.

These data, in combination with the literature reviewed above, demonstrate several important points for those who work in clinics where elders with sexual problems are seen: 1. The currently available literature on the relation of sexual dysfunction to psychiatric disorder in the elderly is not extensive, and much of the literature is limited by methodologic flaws. There is a clear need for improved research methods and a broader data base. Nonetheless, the existing studies indicate that psychologic disorders are found in conjunction with sexual dysfunction commonly enough that clinicians must regularly assess for their presence. 2. The cause of sexual problems is seldom simple or entirely clear. Diagnoses of psychologic concerns and disorders that might relate to sexual dysfunction are common, and most older patients' sexual dysfunction will have a mixed cause, with both medical and psychologic factors playing an important role in the development and maintenance of sexual dysfunction. In our series of patients, 52.8% had diagnosable psychologic difficulties that were assumed to be related to the sexual difficulties. Another large group (39.9%) had psychologic factors (although not diagnosable disorders) that were assumed to contribute to the current manifestation of sexual dysfunction. Thus, it should not be assumed, as it was in years past, that when one likely causative factor is identified (e.g, diabetes, performance anxiety, or depression), the cause of the dysfunction has been identified. 3. The types of psychopathology seen in sex clinics are typically fairly limited, with the largest proportions by far being alcohol abuse or depression (50.1% and 62.1%, respectively, of all psychologic diagnoses in our clinic). Major psychopathology is relatively underrepresented. We suspect this underrepresentation does not reflect a true population characteristic but, rather, a selection difference; patients with major psychopathology such as schizophrenia either do not complain of sexual dysfunction to their therapists or are not referred for treatment by their therapists. 4. The presenting complaints of patients with a psychologic disorder do not differ significantly from those of patients without a psychologic disorder in a general sexual dysfunction clinic. 5. Treatment outcome, especially the rate of successful treatment, does not differ between those with and those without psychologic diagnoses when physicians and psychologists work together on an interdisciplinary team to offer treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

The case of Claire Conroy: will administrative review safeguard incompetent patients?

The emotional issue of withdrawing feeding tubes from incompetent patients was reviewed recently by the New Jersey Supreme Court in the case of Claire Conroy. The court ruled that artificial feedings do not differ from other life-sustaining treatments and may be withdrawn or withheld if they are against the patient's wishes or best interests. The ruling rejected the tradition of shared decision making by physicians and families of incompetent patients. Instead, the court required the State Ombudsman to investigate cases like that of Claire Conroy as possible cases of elder abuse. Although such review was intended to safeguard vulnerable patients, it may have detrimental effects and impede humane decisions to withhold care. To minimize cumbersome decision-making procedures, physicians should discuss life-sustaining treatment in advance with patients who are still competent. Such discussions should be more specific than is now customary.