[:en]When is time to consider palliation in the general therapeutic plan in senior patients?[:ro]Când spunem stop medicaţiei şi start paliaţiei?[:]

[:en]Ioana Dana Alexa, MD, PhD (a), Anca Iuliana Pîslaru, MD (b)

(a): professor, senior specialist internal medicine and geriatrics, Head of Geriatrics Department University of Medicine and Pharmacy “Gr. T. Popa” Iasi, Clinical Hospital “Dr. C.I. Parhon” Iasi, Romania
(b): specialist geriatrics-gerontology, Clinical Hospital “Dr. C.I. Parhon” Iasi, Romania

Corresponding authors: Dr Ioana Dana Alexa: ioana.b.alexa@gmail.com


Population aging is a real challenge for health and medical care systems, especially as a senior population is a heterogeneous one. We encounter several categories, classification based not only on the age group – the older, the more afflicted – but also based on the frailty degree, the presence of handicap or dependency and the need for palliative care.

The expansion of palliative care domain of interest beyond the final period of oncologic patients had led to new and beneficial therapeutic approaches that all physicians should be informed about.

Case presentation:
We present the case of a very old female patient, with a complex personal history, who was admitted in the Geriatric Clinic for a severe urinary tract infection, possibly related to a recent trauma with fall. Despite the complex and intensive treatment, the evolution was not favourable, probably due to her multiple concomitant diseases and advanced degree of frailty. She started to demand insistently to be discharged home, as she could feel her end of life approaching. Unfortunately, her family not only refused the discharge, but also insisted on continuing aggressive treatment and investigations. This appalling dissociation between the patient’s and the family’s wishes carried on until the death of the patient.

We consider that reducing intensive medication and acceptation of palliative care would have restored some of her quality of life and the dignity of our patient before the end of the road. However, the lack of information of her family about the new role of palliation did not allow us to change the therapy. This situation is quite characteristic for Romania, where the lack of education and information about the possibilities of management of the last period of life led to sad situations as the one presented.

Acquiring better information about the role of palliative care in the last period of life of senior patients with severe medical problems is a must in modern Romanian medical society.

Key words: senior patients, polypharmacy, palliative care

(Full text in Romanian)

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