Thus, it should have a multi-dimensional approach, involving a variety of psychological, social, emotional and spiritual elements, in addition to the physical ones. Our first pierde grăsimea is a clinically frail lady with important cardiovascular pathology hospitalized for an acute infectious episode pneumonia.
She recovers well due to simultaneous treatment of both acute episode and frailty. The evolution of the acute pulmonary infection has been influenced more by the degree of frailty than by the pre-existent cardiovascular condition.
Citește Următorul: 15 alimente finale cu ardere de grăsimi În căutarea slăbește rapid într-un mod sănătos? De fapt, sondajele arată că aproximativ 15 la sută dintre adulții din SUA au utilizat acum suplimente dietetice pentru pierderea în greutate la un moment dat în viața lor, cu mai multe femei în jur de 20 la sută de raportare în comparație cu bărbații. Există o diferență cheie între modul în care suplimentele sunt reglementate față de modul în care sunt medicamente sau alte medicamente. Sunt considerate suplimente alimentare în condiții de siguranță până nu sunt sigure, în timp ce contrariul este valabil în cazul medicamentelor eliberate pe bază de rețetă: acestea sunt ținute la îndemâna publicului până când studiile clinice demonstrează că sunt, în general, eficiente și, de asemenea, nefavorabile pentru majoritatea pacienților care le iau. Știind că suplimentele dietetice - inclusiv pastilele pentru pierderea în greutate, ierburile, enzimele și ceaiurile - nu sunt reglementate de Food and Drug Administration FDA în moduri în care sunt și alte medicamente, este posibil să vă întrebați dacă sunt sigure pentru consum.
The second patient had a more severe class of frailty so her recovery was not as good as in the previous case. It is to be noticed that frailty is a negative predictor in the evolution of geriatric patient and leads to co morbidity aggravation.
The third case represents an obvious frail elderly lady with a series of adverse events lives alone, has no family but no major co morbidities. Conclusions: These cases suggest that old age has some particular characteristics: frailty, functional dependence, cognitive impairment, multiple co morbidities, and symptom distress that may be persistent for many years.
In the frail elderly, disease-specific treatments may ameliorate disease but are unlikely to eliminate it. Thus, palliative care is centred on the identification and amelioration of functional and cognitive impairment, postpone development of frailty and increase quality of life.
In response to the unique needs of elderly, palliative care should be considered an essential part of geriatric medicine.
Key words: frailty, palliative care, quality of life Introduction Frailty is a clinical state of high vulnerability and reduced ability to maintain homeostasis. This vulnerability is not only age-related, but also related to disability and co morbidity.
Frailty should have a multi-dimensional approach, involving a variety of psychological, social, emotional and spiritual elements, in addition to the physical ones. The cornerstone of frailty is sarcopenia and its harmful consequences: loss of muscle strength, loss of mobility, neuromuscular impairment, and homeostatic failure 8, 9.
Sarcopenia increases the risk of falls and fractures, it interferes with the nutrition skills empty refrigerator and favours the decline of the protein reserve of the body In addition to being highly prevalent in elderly population, frailty also exert a substantial impact on quality of life.
Cronos Bodydrain - Cronos Diet
It is a multifactorial, complex condition in which many risk factors interact and affect different organ systems, influencing clinical presentation, course of disease s and outcome of elderly patient. As it is extremely challenging by defying conventional medical wisdom and crossing traditional clinical boundaries, frailty fully qualifies as a new geriatric syndrome 7.
Lang et al. The preclinical ameliorarea pierderii în greutate homeostas encompasses the situations when the organism has enough physiological reserves to correctly respond to stressors acute onset of a disease or aggravation of a previous one and the recovery should be complete. In the stage of clinical frailty, the functional reserves are insufficient and the recovery is incomplete. The final stage is that of frailty complications, resulting from physiological vulnerability and reduction of functional reserves.
6 Arzătoare de grăsime naturale și sigure, plus Riscuri de suplimente de pierdere în greutate
This last stage leads to a high risk of falls, disability, polimedication, long-term hospitalizations, severe infections, institutionalization and death. The clinical diagnosis of frailty is based on a multitude of signs and symptoms, such as weakness, fatigue, weight loss, decreased capacity to maintain balance, low level of physical activity, loss of motor performance, social withdrawal, mild cognitive disorder and growth of vulnerability to stress.
There were several approaches to identify frailty. One was developed by Rockwood et al. A second approach considers that frailty has a distinct pathophysiology and its own clinical presentation Fried et al.
Meeting three out of five criteria define the frail elderly, and ameliorarea pierderii în greutate homeostas or two out of five criteria define the preclinical form.
Having in mind the functional downwards trajectory towards the end-of- life of the frail elderly, many authors agree to invite palliative care to be an essential part of the complex management of geriatric patient Another problem resides with finding the right moment to initiate palliative care. The evolution was not favourable and she was admitted in our clinic. She had dyspnoea, cough with muco-purulent sputum, sweating, nausea, weight loss approximately 5 kg in the last yearand fatigue.
She had a history of hypertension, angina with left bundle branch block, and stroke with secondary right hemi paresis.
Schizandra sau vița de magnolie chineză În medicina chineză, fructele de schizandra sunt considerate unice deoarece au toate cele cinci arome: picant, sărat, amar, dulce și acru. Deși nu mulți oameni știu despre asta, Schisandra este un adaptogen puternic al plantei care are un efect stabilizator asupra întregului corp.
She lives in the countryside with her family and she benefits from family support. Need for assistance has increased from the moment of aggravation of respiratory disease and the 3-days bed rest. The patient has geriatric frailty syndrome neglected in the last year and aggravated progressively in the last days.
Due to the multidisciplinary approach, including palliative care correct and complete medical treatment, correct diet, physical therapy and adequate family support she did very well during hospitalization: she acquired autonomy for ADL and decreases the level of assistance for IADL, she started to eat on her own and had a weight gain of 2 kg.
She started to walk, first with the support of the family members and with a walker when discharged home. Later reevaluations showed that she maintained a good functional and nutritional baseline. She was referred to our clinic by ambulance for fatigue, excessive sleepiness, temporal-spatial disorientation, intense pallor, and weight loss of approximately 10 kg in the last year. She has been living alone in an apartment since her husband died 4 years earlier but she has a caregiver who comes every day.
The family noticed depression and loss of appetite, refusing food for the last couple of weeks.
Cum să luați adaptogeni pe bază de plante. Cercetare de baza. Adaptogeni eficienți ai plantelor
She had a history of diabetes, hypertension and anaemia but without any medical records. The very first investigations showed severe macrocytic anaemia which requested several blood transfusions. Comprehensive geriatric assessment was performed after the management of the acute episode. She did well during hospitalization with the help of the multidisciplinary team: she resumed feeding, initially with the help of the family and caregivers, later on her own. She started to walk under the supervision of the physiotherapist, initially for short distances with bilateral support, then longer distances with the help of a cane.
She gained weight, approximately 3 kg. In 6 months time she surpassed her previous functional and psychological baseline, mostly due to correct multidisciplinary approach, including palliative care and increased family support that motivated her to fight frailty and win the battle.
She had a history of congestive heart failure, severe degenerative aortic stenosis, severe mitral insufficiency, permanent atrial fibrillation, iron deficiency anaemia, chronic venous insufficiency, chronic kidney disease stage 3, severe hearing impairment and numerous abdominal interventions she could not account for.
She lived alone, and could give no information about her treatment. We started a complex therapy, including nutritional assistance, physical therapy, adequate medication and psychological support. The cardiac surgeon considered that a valvuloplasty was hazardous and the patient refused surgery anyway. From the first day in the Geriatric Clinic, we associated palliation to our complex medical treatment and it goes without saying that palliative care has had its place in optimizing her quality of life.
Pain management, adequate nutrition, constant help in understanding the evolution of her multiple diseases and her choices in medication, affectionate assistance in her daily needs were just part of her complex treatment.
Discussions We consider that these 3 cases are illustrative for the frailty syndrome.
Even if the three patients had different pathologies, they still had several common features: weight loss, no physical activity, fatigue, ameliorarea pierderii în greutate homeostas degrees of depression and mild cognitive impairment.
All these represent the frailty phenotype observed as being more or less pregnant with the three patients described earlier. These cases suggest that old age has some particular characteristics: frailty, functional dependence, cognitive impairment, multiple co morbidities, and symptom distress that may be persistent for many years.
In the frail elderly, disease-specific treatments may ameliorate disease but are unlikely to eliminate it References 1.
Bortz WM 2nd. The physics of frailty. J Am Geriatr Soc ;41 9 Fisher AL. Just what defines frailty?
J Am Geriatr Soc ;53 12 The identification of frailty: a systematic literature review. J Am Geriatr Soc ;59 11 Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project.
Ferrazzoli D, Sancesario G. Development and significance of the frailty concept in the elderly: a possible modern view. Bandinelli B, Bartalli S. A randomized, controlled trial of disability prevention in frail older patients screened in primary care: the FRASI study. Design and baseline evaluation.
Aging Clin Exp Res Mühlberg W, Sieber C.