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At peace : choosing a good death after a long life
\"The authoritative, informative, and practical follow up to BEING MORTAL, on end-of-life care for patients over the age of 65. Most people say they would like to die quietly at home. But overly aggressive medical advice, coupled with an unrealistic sense of invincibility, results in the majority of elderly patients misguidedly dying in institutions while undergoing painful procedures, instead of having the better and more peaceful death they desired. At Peace outlines specific active and passive steps that older patients and their health care proxies can take to insure loved ones pass their last days comfortably at home and/or in hospice, when further aggressive care is inappropriate. Through Dr. Harrington's own experience with his parents and patients, he describes the terminal patterns of the six most common chronic diseases; how to recognize a terminal diagnosis even when the doctor is not clear about it; how to have the hard conversation about end-of-life wishes; how to minimize painful treatments; when to seek hospice care; and how to deal with dementia and other special issues. Informed by more than thirty years of clinical practice, Dr. Harrington came to understand that the American health care system wasn't designed to treat the aging population with care and compassion. His work as a hospice trustee and later as a hospital trustee informed his passion for helping patients make appropriate end-of-life decisions\"-- Provided by publisher.
Finishing our story : preparing for the end of life
\"Death is the destiny we all share, and this will not change. Yet the way we die, which had remained the same for many generations, has changed drastically in a relatively short time for those in developed countries with access to healthcare. For generations, if people were lucky enough to reach old age, not having died in infancy or childhood, in childbirth, in war, or by accident, they would take to bed, surrounded by loved ones who cared for them, and fade into death. Most likely, they would have seen their parents and grandparents die the same way, and so this manner of dying would be familiar: it was part of the natural cycle of life. Now less than 25 per cent of Americans die at home, having reached much older ages than people would have dreamed of in past generations, often after surviving many illnesses and even diseases that would have been terminal for their grandparents. We are fortunate to live (and die) today, supported by myriad scientific, medical, and technological advancements, however we also face new problems as a result of the new way in which we die. We can no longer anticipate a peaceful waning at home with family. We know our lives will likely end in hospitals likely after we have endured grueling treatments to prolong life. We have to decide what decisions we want our loved ones, or care-givers, to make when we cannot choose for ourselves. We have to think about whether in any circumstances we would seek physician-assisted death. We know we face other questions as well, but we may not even know where to start. In the face of these decisions, we can feel daunted and afraid. The best remedy is information and planning. In this book, Gregory Eastwood - a physician who has cared for dying patients, served as an ethics consultant, and taught end of life issues to medical and other health profession students - draws from his substantial experience with patients and families to provide the information that will help us think clearly about the choices and issues we will face at the end of our own lives, and when faced with the deaths of our loved ones. With sensitivity and profound insight, Eastwood guides us through all the important questions about death and dying in straightforward, clear language, enhanced by real-life stories. Throughout, he shows us how we can take ownership of the way we want to die, when we must die, and feel more in control as death approaches. \"-- Provided by publisher.
Incidence and Clinical Characteristics of Respiratory Sarcopenia in Community-Dwelling Older Adults: A Cross-Sectional Study
2025
This study aimed to determine the prevalence, characteristics, and associated factors of respiratory sarcopenia in community-dwelling older adults.
This cross-sectional study included 369 community-dwelling older adults aged 65 years and above, living in Koto-ku, Tokyo, Japan. Measurements included body composition, physical function (grip strength, walking speed, and 5 chair-stand, 5CS, test), physical activity (the International Physical Activity Questionnaire-Short Form), respiratory muscle strength (%Maximal Inspiratory Pressure, %MIP, and %Maximal Expiratory Pressure, %MEP), oral function (oral diadochokinesis, ODK; tongue pressure), cognitive function (Montreal Cognitive Assessment-Japanese), and health-related quality of life (the MOS 8-Item Short-Form Health Survey). Participants were classified into three mutually exclusive groups based on respiratory muscle strength and limb skeletal muscle mass. The Probable respiratory sarcopenia group (Probable group) included individuals with both reduced respiratory muscle strength (defined as both %MIP and %MEP values below 80%) and low limb skeletal muscle mass (defined as <7 kg/m² in men and <5.7 kg/m² in women, based on the Asian Working Group of Sarcopenia 2019). The Possible respiratory sarcopenia group (Possible group) included participants with reduced respiratory muscle strength alone but normal skeletal muscle mass. The Robust group comprised those with neither respiratory muscle weakness nor low skeletal muscle mass. The prevalence of each group was calculated separately. For further analysis, the Probable and Possible groups were combined into a single respiratory sarcopenia group, and the Robust group was used as the control. A t-test, Mann-Whitney U test, and chi-square test were used to compare the characteristics of each group. Logistic regression analysis was then performed to identify factors associated with the presence of respiratory sarcopenia.
The prevalence of Probable respiratory sarcopenia was 3.3%, and that of Possible respiratory sarcopenia was 33.3%. Compared with the Robust group, the respiratory sarcopenia group exhibited significantly poorer physical function, including grip strength, gait speed, 5CS performance, physical activity, and oral function. Additionally, cognitive function was significantly lower in the respiratory sarcopenia group. Significant factors associated with respiratory sarcopenia included grip strength, 5CS, moderate physical activity, tongue pressure, and fat-free mass.
The prevalence of Probable respiratory sarcopenia and Possible respiratory sarcopenia among community-dwelling older adults was 3.3% and 33.3%, respectively. Respiratory sarcopenia was characterized by significantly lower physical function (grip strength, gait speed, and 5CS), physical activity, oral function (ODK and tongue pressure), and cognitive function. Furthermore, grip strength, 5CS score, moderate physical activity, and tongue pressure were identified as significant factors associated with respiratory sarcopenia, suggesting that it requires a comprehensive evaluation including physical function, physical activity, oral function, and cognitive function.
Journal Article