FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2085372218> ?p ?o ?g. }

• W2085372218 endingPage "1013" @default.
• W2085372218 startingPage "1012" @default.
• W2085372218 abstract "To the Editor:—Protein-energy undernutrition is a common problem among older persons.1, 2 Recently there has been increased awareness that many older persons who are losing weight have an identifiable and treatable cause.3 A recent malnourished older patient presented me with a diagnostic and ethical dilemma. I believe this case report provides useful information for other physicians. E.R. was an 85-year-old who presented in my office 14 days after a fall complaining of lumbar and sacral pain. On X-ray she had severe degenerative disease of the spine, with osteophytosis and compression fractures of T11 and L1. Severe osteopenia was present. Her husband had died 32 years ago. She lived alone in an apartment. She had two children. She scored 19/30 on the Folstein Mini-Mental State Examination and 26/30 on the Yesavage Geriatric Depression Scale. She admitted to being lonely. She had a poor appetite, had lost “a lot of weight,” and felt she was malnourished. She weighed 97 pounds. Her albumin was 3.7 g/dL. Further questioning elicited that she had weight-restricted all her life and that her husband had always told her that she weighed too much. She used to starve herself one day a week. Treatment was tried with trazodone up to 150 mg daily. She lost 4 pounds over the next 8 weeks, and treatment was changed to desipramine. The original diagnosis was depression with an anorexia nervosa variant. Her depression improved, but she continued to lose weight down to 78 pounds. She had numerous aches and pains. She felt that life was extremely burdensome. During a home visit, she made it clear that she was terrified of being forced to go into a nursing home. She was happy in her home environment. She refused hospitalization or a feeding tube. After a protracted discussion with the patient and her family, it was decided that she would be allowed to stay at home, and I would provide home visits to treat any terminal illness that might develop. She had fallen outside her apartment and had fought off the emergency medical service when they had attempted to take her to the hospital. An ethics consult was obtained and concurred with the concept that therapy should not be forced on the patient. A diagnosis of “overwhelming burden of life” was made, all therapy stopped, and she was certified for home hospice care. Six months later, the patient returned to see me in my office as her hospice benefits had run out. She now weighed 100 pounds. She continued to avow that she would not accept hospitalization or any other treatment. She stated that she did not want to gain weight. She was seen again 18 months after her initial presentation. She weighed 104 pounds. This patient clearly had a lifetime history of weight restricting and could meet other diagnostic criteria for anorexia nervosa with associated depression. A number of such cases have been reported in older persons.4 Anorexia nervosa patients may show spontaneous recovery as may patients with depression.5 The unique aspect of this case was that the patient continued to lose weight until she was assured that no attempt would be made to force her to be treated. She had a morbid fear of being forced out of her house and into a nursing home. The ethical dilemma of when a patient who has some degree of depression may refuse further treatment is a difficult one. In her case, her happiness in her home situation convinced me that she was entitled to refuse treatment, and intervention would have been excessive protectionism. Our ethicist agreed with this formulation. The patient's recovery was completely unexpected. The recovery could be seen psychologically in terms of returning to the patient her locus of control and thus giving her the fortitude to continue to live." @default.
• W2085372218 created "2016-06-24" @default.
• W2085372218 creator A5006935353 @default.
• W2085372218 date "1993-09-01" @default.
• W2085372218 modified "2023-09-23" @default.
• W2085372218 title "The Strange Case of an Older Woman Who Was Cured by Being Allowed to Refuse Therapy" @default.
• W2085372218 cites W2036565995 @default.
• W2085372218 cites W2068670679 @default.
• W2085372218 cites W2079357309 @default.
• W2085372218 cites W2122860259 @default.
• W2085372218 cites W2329558974 @default.
• W2085372218 doi "https://doi.org/10.1111/j.1532-5415.1993.tb06774.x" @default.
• W2085372218 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/8409173" @default.
• W2085372218 hasPublicationYear "1993" @default.
• W2085372218 type Work @default.
• W2085372218 sameAs 2085372218 @default.
• W2085372218 citedByCount "4" @default.
• W2085372218 countsByYear W20853722182012 @default.
• W2085372218 crossrefType "journal-article" @default.
• W2085372218 hasAuthorship W2085372218A5006935353 @default.
• W2085372218 hasConcept C141071460 @default.
• W2085372218 hasConcept C61434518 @default.
• W2085372218 hasConcept C71924100 @default.
• W2085372218 hasConceptScore W2085372218C141071460 @default.
• W2085372218 hasConceptScore W2085372218C61434518 @default.
• W2085372218 hasConceptScore W2085372218C71924100 @default.
• W2085372218 hasIssue "9" @default.
• W2085372218 hasLocation W20853722181 @default.
• W2085372218 hasLocation W20853722182 @default.
• W2085372218 hasOpenAccess W2085372218 @default.
• W2085372218 hasPrimaryLocation W20853722181 @default.
• W2085372218 hasRelatedWork W2002120878 @default.
• W2085372218 hasRelatedWork W2003938723 @default.
• W2085372218 hasRelatedWork W2047967234 @default.
• W2085372218 hasRelatedWork W2118496982 @default.
• W2085372218 hasRelatedWork W2364998975 @default.
• W2085372218 hasRelatedWork W2369162477 @default.
• W2085372218 hasRelatedWork W2439875401 @default.
• W2085372218 hasRelatedWork W4238867864 @default.
• W2085372218 hasRelatedWork W2519357708 @default.
• W2085372218 hasRelatedWork W2525756941 @default.
• W2085372218 hasVolume "41" @default.
• W2085372218 isParatext "false" @default.
• W2085372218 isRetracted "false" @default.
• W2085372218 magId "2085372218" @default.
• W2085372218 workType "article" @default.