Palliative care in the ambulatory geriatric practice.
Geriatrics and palliative care often overlap. This article focuses on 2 areas where the disciplines may differ in their approach. The first is planning for extreme illness and death, with explicit acknowledgment that limiting therapy might be a good idea. This situation is likely to have a different impact in the course of a routine geriatrics visit than in a palliative care context. The second is pain management, especially chronic pain. In patients with sharply limited life expectancy, the risk/benefit equation tilts easily toward narcotic use. In frail elders working to remain independent, the calculus may be quite different.
Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Beacham Ambulatory Care Clinic, Johns Hopkins Bayview Medical Center, 5505 Hopkins Bayview Circle, John R. Burton Pavilion, Baltimore, MD 21224, USA. Electronic address: tfinucan@jhmi.edu.
Thomas E
TE
Finucane
Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Beacham Ambulatory Care Clinic, Johns Hopkins Bayview Medical Center, 5505 Hopkins Bayview Circle, John R. Burton Pavilion, Baltimore, MD 21224, USA.
Olivia
O
Nirmalasari
Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Beacham Ambulatory Care Clinic, Johns Hopkins Bayview Medical Center, 5505 Hopkins Bayview Circle, John R. Burton Pavilion, Baltimore, MD 21224, USA.
Antonio
A
Graham
D032722:Advance Care Planning; D000368:Aged; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy; D016330:Frail Elderly / Q000523:psychology*; D015577:Geriatric Assessment; D006299:Health Services for the Aged; D006801:Humans; D008017:Life Expectancy; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D011788:Quality of Life
Advance care planning; Elderly; Geriatrics; Pain management