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When is enough is enough? appropriate care at the end of life

When is enough is enough? appropriate care at the end of life. Ngaire Kerse, PhD, MBChB. Professor, General Practice and Primary Health Care, University of Auckland . NATURE|Vol 464|25 March 2010| doi:10.1038/nature08984.

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When is enough is enough? appropriate care at the end of life

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  1. When is enough is enough? appropriate care at the end of life Ngaire Kerse, PhD, MBChB Professor, General Practice and Primary Health Care, University of Auckland

  2. NATURE|Vol 464|25 March 2010|doi:10.1038/nature08984

  3. Mortality, by age, by calendar year, New Zealand men, non-Maori 1900 - 2006 death rates are falling in all age groups.

  4. Years of life left

  5. Proportion remaining after 1 year

  6. Age and variation Birth Older age Context

  7. Fortune, Mood,~ 1/3 Habits, Fitness, ~ 1/3 Society, Healthcare ~1/3

  8. Of those 85+ • 75% independent in community • 23% working • 60% driving • 10% (in community) significant disability • 67% with CVD, 30% 5y CVD mortality • co-morbidities common

  9. To avoid • Long term non-steroidal anti-inflammatory drugs • Gastrointestinal haemorrhage, renal impairment, hypertension • Benzodiazepines • Falls caused by impaired balance • Anticholinergic drugs • Unmasking Alzheimer’s disease, urinary retention • Tricyclic antidepressants • Orthostatic hypotension, sedation • Chlorpropramide • Hypoglycaemia • Doxazosin • Orthostatic hypotension, dry mouth, urinary problems Milton, BMJ 2008

  10. Warfarin for Afib ACE and β blockers for LVF Statins for high cholesterol Bisphosphonates for osteoporosis Aspirin Often underprescribed Milton, BMJ 2008

  11. CVD events Serious adverse event

  12. CVD events Serious adverse event Selak, Elley, 2010, JPHC

  13. Atrial Fibrillation and warfarin • Even Mike said he would take warfarin

  14. When is enough enough? • When the patient says so

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