Although end-of-life care is a relatively common option for patients with terminal cancer, it has... more Although end-of-life care is a relatively common option for patients with terminal cancer, it has become available only recently for patients with Alzheimer's disease. Alzheimer's disease is a chronic process of gradual deterioration of cognitive ability and the resulting deficits in activities of daily living. The chronic disease course of Alzheimer's disease gives to the clinician the opportunity to look ahead and plan for the final stages of care. This article presents a review of palliative care interventions for patients with Alzheimer's disease and other dementias. End-of-life care for individuals with end-stage Alzheimer's disease is increasingly important because of the increasing number of patients with this disease. However, there are barriers to providing high-quality end-of-life care. Currently, palliative care is not optimal for Alzheimer's patients. Health care systems and clinicians should make efforts to improve the suffering of patients with ...
A COMMON SYMPTOM: Pain is a common and underestimated problem in older people who are likely to s... more A COMMON SYMPTOM: Pain is a common and underestimated problem in older people who are likely to suffer from many acute and chronic conditions. DIFFICULT ASSESSMENT: Clinical assessment of pain often depends on the patient's ability to communicate his or her experience. If self-assessment of pain is not possible, behavioral hetero-evaluation instruments have been built for easy pain assessment by caregivers. ADJUSTED PAIN MANAGEMENT: As for younger patients, the most common strategy for pain management is the use of analgesic drugs. Special care should be taken however when such drugs are initiated in the elderly because increased sensitivity, prolonged drug half-life and adverse effects and drug interactions are more likely.
The institutional management for demented patients has been improved by new specific treatments, ... more The institutional management for demented patients has been improved by new specific treatments, behavioural approach, better architectural adaptation, and environmental characteristics. This management must be global, including patients, families and nursing staffs. The nursing staff must be diversified, motivated, and specifically trained to manage demented patients.
ABSTRACT With the aging population, physicians are increasingly faced with dementia and the diffi... more ABSTRACT With the aging population, physicians are increasingly faced with dementia and the difficulty of assessing the ability of these patients to drive. In a geriatric day hospital, we compared a group of drivers with normal cognitive functions (n = 28) and a group of drivers with dementia (n = 57). Age, sex, antecedents (consciousness loss, diabetes, alcohol consumption), IADL, psychotropic treatment, test of five words and Trail Making Test (TMT) B do not appear as risk factors for road accidents. For “one-leg balance” there is a statistically significant difference between healthy drivers (89.3% success), demented drivers (62.5% success) and demented patients who have stopped driving (17.6% success, P < 0.0001). Our study highlights an increased risk of road accidents in patients with early dementia (MMS ≥ 21). The cessation of driving should be envisaged in the early stages of the disease. However, the consequences of that decision must be taken into account. A multidisciplinary assessment is necessary. These results highlight the value of balance evaluation in addition to cognitive assessment. Present research is towards developing appropriate evaluation methods, without stigmatizing the elderly.
In elderly institutionalized people, confined to bedroom and receiving no vitamin D supplementati... more In elderly institutionalized people, confined to bedroom and receiving no vitamin D supplementation, the frequency of vitamin D deficiency is found very high. Systematic administration of vitamin D has, therefore, been proposed to correct vitamin D deficiency. Within this context, we studied 40 elderly institutionalized subjects (mean age 80.5 + 7.2 yr) with low 25(OH)D3 concentrations (4.4 + 1.8 micrograms/l). Sixteen of them (Group I) had low serum calcium concentrations (less than 2.3 mmol/l) and 24 (Group II) had normal serum calcium concentrations (from 2.3 to 2.6 mmol/l). As hypocalcemia has been shown to regulate 1,25(OH)D3 production independent of PTH in animals and in humans, we compared their respective responses to the administration of vitamin D3. Subjects received a total dose of 15 mg (600,000 IU) of vitamin D3 divided into 3 i.m. injections at one month intervals and were explored before therapy and one and 6 months after the last dose of vitamin D3. The treatment in...
... Ainsi, dans une étude italienne [26] en soins de longue durée, 20,5% des patients atteints de... more ... Ainsi, dans une étude italienne [26] en soins de longue durée, 20,5% des patients atteints de maladie d'Alzheimer en fin de vie ont eu une sonde d'alimentation ou une gastrotomie et 66,6 % une hydratation intraveineuse. ... [13] Kammoun S, Gold G, Herrmann F, et al. ...
Although end-of-life care is a relatively common option for patients with terminal cancer, it has... more Although end-of-life care is a relatively common option for patients with terminal cancer, it has become available only recently for patients with Alzheimer's disease. Alzheimer's disease is a chronic process of gradual deterioration of cognitive ability and the resulting deficits in activities of daily living. The chronic disease course of Alzheimer's disease gives to the clinician the opportunity to look ahead and plan for the final stages of care. This article presents a review of palliative care interventions for patients with Alzheimer's disease and other dementias. End-of-life care for individuals with end-stage Alzheimer's disease is increasingly important because of the increasing number of patients with this disease. However, there are barriers to providing high-quality end-of-life care. Currently, palliative care is not optimal for Alzheimer's patients. Health care systems and clinicians should make efforts to improve the suffering of patients with this disease and their caregivers.
Journal of Epidemiology and Community Health, 1992
STUDY OBJECTIVE--The aim was to compare digital and palmar dermatoglyphics in subjects with demen... more STUDY OBJECTIVE--The aim was to compare digital and palmar dermatoglyphics in subjects with dementia of Alzheimer type and in mentally healthy elderly controls. DESIGN--This design was a case-control study. SETTING--The study was carried out in geriatric units and retirement communities in the Paris area. PARTICIPANTS--Cases were women with clinically diagnosed Alzheimer type dementia according to DSM III-R criteria (n =
Although end-of-life care is a relatively common option for patients with terminal cancer, it has... more Although end-of-life care is a relatively common option for patients with terminal cancer, it has become available only recently for patients with Alzheimer's disease. Alzheimer's disease is a chronic process of gradual deterioration of cognitive ability and the resulting deficits in activities of daily living. The chronic disease course of Alzheimer's disease gives to the clinician the opportunity to look ahead and plan for the final stages of care. This article presents a review of palliative care interventions for patients with Alzheimer's disease and other dementias. End-of-life care for individuals with end-stage Alzheimer's disease is increasingly important because of the increasing number of patients with this disease. However, there are barriers to providing high-quality end-of-life care. Currently, palliative care is not optimal for Alzheimer's patients. Health care systems and clinicians should make efforts to improve the suffering of patients with ...
A COMMON SYMPTOM: Pain is a common and underestimated problem in older people who are likely to s... more A COMMON SYMPTOM: Pain is a common and underestimated problem in older people who are likely to suffer from many acute and chronic conditions. DIFFICULT ASSESSMENT: Clinical assessment of pain often depends on the patient's ability to communicate his or her experience. If self-assessment of pain is not possible, behavioral hetero-evaluation instruments have been built for easy pain assessment by caregivers. ADJUSTED PAIN MANAGEMENT: As for younger patients, the most common strategy for pain management is the use of analgesic drugs. Special care should be taken however when such drugs are initiated in the elderly because increased sensitivity, prolonged drug half-life and adverse effects and drug interactions are more likely.
The institutional management for demented patients has been improved by new specific treatments, ... more The institutional management for demented patients has been improved by new specific treatments, behavioural approach, better architectural adaptation, and environmental characteristics. This management must be global, including patients, families and nursing staffs. The nursing staff must be diversified, motivated, and specifically trained to manage demented patients.
ABSTRACT With the aging population, physicians are increasingly faced with dementia and the diffi... more ABSTRACT With the aging population, physicians are increasingly faced with dementia and the difficulty of assessing the ability of these patients to drive. In a geriatric day hospital, we compared a group of drivers with normal cognitive functions (n = 28) and a group of drivers with dementia (n = 57). Age, sex, antecedents (consciousness loss, diabetes, alcohol consumption), IADL, psychotropic treatment, test of five words and Trail Making Test (TMT) B do not appear as risk factors for road accidents. For “one-leg balance” there is a statistically significant difference between healthy drivers (89.3% success), demented drivers (62.5% success) and demented patients who have stopped driving (17.6% success, P < 0.0001). Our study highlights an increased risk of road accidents in patients with early dementia (MMS ≥ 21). The cessation of driving should be envisaged in the early stages of the disease. However, the consequences of that decision must be taken into account. A multidisciplinary assessment is necessary. These results highlight the value of balance evaluation in addition to cognitive assessment. Present research is towards developing appropriate evaluation methods, without stigmatizing the elderly.
In elderly institutionalized people, confined to bedroom and receiving no vitamin D supplementati... more In elderly institutionalized people, confined to bedroom and receiving no vitamin D supplementation, the frequency of vitamin D deficiency is found very high. Systematic administration of vitamin D has, therefore, been proposed to correct vitamin D deficiency. Within this context, we studied 40 elderly institutionalized subjects (mean age 80.5 + 7.2 yr) with low 25(OH)D3 concentrations (4.4 + 1.8 micrograms/l). Sixteen of them (Group I) had low serum calcium concentrations (less than 2.3 mmol/l) and 24 (Group II) had normal serum calcium concentrations (from 2.3 to 2.6 mmol/l). As hypocalcemia has been shown to regulate 1,25(OH)D3 production independent of PTH in animals and in humans, we compared their respective responses to the administration of vitamin D3. Subjects received a total dose of 15 mg (600,000 IU) of vitamin D3 divided into 3 i.m. injections at one month intervals and were explored before therapy and one and 6 months after the last dose of vitamin D3. The treatment in...
... Ainsi, dans une étude italienne [26] en soins de longue durée, 20,5% des patients atteints de... more ... Ainsi, dans une étude italienne [26] en soins de longue durée, 20,5% des patients atteints de maladie d'Alzheimer en fin de vie ont eu une sonde d'alimentation ou une gastrotomie et 66,6 % une hydratation intraveineuse. ... [13] Kammoun S, Gold G, Herrmann F, et al. ...
Although end-of-life care is a relatively common option for patients with terminal cancer, it has... more Although end-of-life care is a relatively common option for patients with terminal cancer, it has become available only recently for patients with Alzheimer's disease. Alzheimer's disease is a chronic process of gradual deterioration of cognitive ability and the resulting deficits in activities of daily living. The chronic disease course of Alzheimer's disease gives to the clinician the opportunity to look ahead and plan for the final stages of care. This article presents a review of palliative care interventions for patients with Alzheimer's disease and other dementias. End-of-life care for individuals with end-stage Alzheimer's disease is increasingly important because of the increasing number of patients with this disease. However, there are barriers to providing high-quality end-of-life care. Currently, palliative care is not optimal for Alzheimer's patients. Health care systems and clinicians should make efforts to improve the suffering of patients with this disease and their caregivers.
Journal of Epidemiology and Community Health, 1992
STUDY OBJECTIVE--The aim was to compare digital and palmar dermatoglyphics in subjects with demen... more STUDY OBJECTIVE--The aim was to compare digital and palmar dermatoglyphics in subjects with dementia of Alzheimer type and in mentally healthy elderly controls. DESIGN--This design was a case-control study. SETTING--The study was carried out in geriatric units and retirement communities in the Paris area. PARTICIPANTS--Cases were women with clinically diagnosed Alzheimer type dementia according to DSM III-R criteria (n =
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Papers by Dorin Feteanu