The inaccessibility of advance directives on transfer from ambulatory to acute care settings

Article Abstract:

A low percentage of patients' advanced directives concerning their medical care appear to be available when patients are hospitalized. Of 114 patients averaging 83 years of age and accounting for 185 hospital admissions over a three-year period, only 47 (26%) advanced directives were duly noted in hospital charts. In 70 (39%) of the admissions, the admitting clerk had missed the patient's advance directive. In 53 cases where the patient was incapable of making a decision concerning their care, 39 (74%) did not have an advanced directive acknowledged and no attempt was made to secure one. Only one in four of these 53 patients' advanced directives were acknowledged. In the rest of the cases, medical decisions were made without checking previous proxies or living wills by the patients. Admitting clerks, physicians, patients, and families are responsible for finding and carrying out the advanced directives.

Usage, Laws, regulations and rules, Aged patients, Elderly patients, Advance directives (Medicine)

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Palliative care

Article Abstract:

The first diagnosis report and study on the disease of an 85-year-old man with class IV heart failure, hypertension, and moderate Alzheimer's disease are presented. The subsequent care he needed at home after discharging from the hospital is discussed with the medical prescription.

Science & research, Care and treatment, Research, Hypertension, Diagnosis, Palliative treatment, Palliative care, Heart failure, Cookery for hypertensives

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The Inner Life of Physicians and Care of the Seriously Ill. (The Patient-Physician Relationship)

Article Abstract:

A model is presented to help doctors deal with their emotional reactions to critically ill patients. These reactions include feelings of failure, powerlessness, frustration, grief, fear of death, and a desire to avoid patients in order to prevent these feelings.

Psychological aspects, Physicians, Medical professions, Terminal care

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