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  • ISSN: 2378-9409
    Volume 2, Issue 1
    Case Report
    June KY Li*, William KW Lee, Charmaine HM Chan, Ray SN Ng, Bryan KH Wong and KK Mo
    Abstract: We report an elderly man who suffered from episodes of severe life-threatening hypoglycemia during exacerbation of his chronic obstructive airway disease. He presented with ocular myasthenia gravis, followed six months later by Graves' disease with thyrotoxicosis and ophthalmopathy. Two months later, he then presented as severe hypoglycemia at midnight and was found to have insulin autoimmune syndrome. Upon literature search, it was noted that this combination of autoimmune polyendocrine syndrome was rarely reported worldwide except in Japanese. Though aetiology is unknown, correct identification was important to enable immediate appropriate treatment. Our case highlighted the complexity of disease in the elderly. Clinician's alertness to this condition and timely treatment may prevent catastrophic outcomes.
    Alex Mersel1*, V Jerolimov2 and Gil Eisenberg1
    Abstract: No doubt that classical oral rehabilitation is the best choice when resources are sufficient. Nevertheless there is a growing of atypical cases looking for Prosthodontic restoration a d unable to receive a conventional treatment. Edentulism is a debilitating handicap described as: "dentures cripples". Because the dentures will partially rehabilitate the patient at the functional, esthetic and emotional level. Moreover during the transitional period between the dentate status and the edentate situation numerous complications might occur. Therefore the issue of Bio-Ethics led us to develop a care system on more realistic bases. In this article a case report will illustrate this concept.
    James X. Zhang1*, Jhee U. Lee1, Kiran Pandey1 and David O. Meltzer1,2
    Abstract: Cost remains a significant barrier to medications for millions of older Americans despite the institution of the Medicare Part D outpatient prescription drug program. We aimed to evaluate the association of cost-related medication non-adherence (CRN) with functional limitations and frequency of hospitalization among American adults 50 years or older using a nationally representative data set. We used 2010 data from the Health and Retirement Study. Americans 50 years or older were surveyed about their Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), hospital admissions and CRN. Multivariate logistic regression analysis was conducted to assess the relationship between CRN and the number of functional limitations and hospitalizations controlling for socio-demographic variables and insurance status. Out of 20,776 older adults, 2,620 (12.6%) reported CRN. After controlling for insurance type and socio-demographic factors, our multivariate logistic regression analysis found that respondents with 1, 2, and 3 or more ADL limitations were 83%, 110%, and 143% more likely to report CRN than those without any ADL limitations, respectively (p<0.001), with similar but smaller impact of IADLs on CRN. Respondents with 1, 2, and 3 or more hospitalizations were 47%, 62%, and 106% more likely to report CRN than those without any hospitalizations, respectively (p<0.001).Older adults with greater numbers of functional limitations and hospitalizations are more likely to report CRN. CRN continues to be increased for sicker patients and should be the subject of future research to improve social policies and insurance benefit design with the goals of improving access to medications for this population.
    Helen Senderovich*
    Abstract: There comes a point when physicians have to recommend patients to seek Palliative Care due to the deteriorating progression of their illness (es). Healthcare providers often wrongly assume that the families of the patients have a clear idea of the type of care that will be provided, but the providers are usually wrong by assuming this. The families of these patients often have false expectations of the care that their loved one (s) will be receiving, especially in situations where an Advanced Care Plan was not established when the patient still had decision-making capacity. This poses challenges on the healthcare staff. Acting in the patient's best interests, healthcare staffs are trying to balance meeting the healthcare needs of the patient, and expectations of the family, while maintaining both a professional and ethical character. The paper describes a case that addresses some of the conflicts which may arise in settings where Palliative Care is provided. It addresses the challenges that healthcare providers may come across due to the differing expectations and demands from the family members.
    Review Article
    John Ward*
    Abstract: The prevalence of dementia in the community will increase over the next twenty to thirty years by as much as three-fold, making it the most common cause of disability in the community. It can cause great distress to the sufferer but also to the family, who has to manage the functional decline as well as any psychological and behavioural issues. One aspect of the illness, which is rarely mentioned in the textbooks, but is responsible for considerable psychological distress and family stress is the loss of sense of self that accompanies many cases of dementia. Some of this loss of 'self' is inherent in any degenerative disease involving the brain but, in addition, our systems for the assessment and management of dementia in the community can aggravate this loss.
    It is vitally important that all services for dementia, whether in the community or in residential facilities, should be based on principles that promote a sense of self and avoid any interactions that are likely to undermine the 'self'. A model operates in the community in Newcastle, Australia, that meets these principles, but it is vital to develop similar services in all areas of Australia. The concept of 'self' as outlined by Hofstadter provides a framework to develop appropriate services for all stages of dementia, from initial assessment to end-of-life care.
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