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Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
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From Advance Euthanasia Directive to Euthanasia: Stable Preference in Older People?

Eva E Bolt1, H Roeline W Pasman1, Dorly J H Deeg2

  • 1Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VUmc Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, the Netherlands.

Journal of the American Geriatrics Society
|June 16, 2016
PubMed
Summary

Most older adults with an advance directive for euthanasia (ADE) maintain a stable desire for it. However, an ADE does not always lead to a euthanasia request, possibly reflecting a need for future reassurance.

Keywords:
advance care planningadvance directivesend-of-life careeuthanasiaphysician-assisted dying

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Area of Science:

  • Gerontology
  • Medical Ethics
  • Palliative Care

Background:

  • Advance directives for euthanasia (ADEs) allow individuals to pre-state their wishes regarding end-of-life care.
  • Understanding the stability of these desires and the factors influencing requests is crucial for patient autonomy and care planning.

Purpose of the Study:

  • To assess the stability of expressed desires for euthanasia among older adults with ADEs.
  • To determine the frequency of euthanasia requests in this population.
  • To identify factors influencing euthanasia requests in individuals with ADEs.

Main Methods:

  • A mortality follow-back study nested within a cohort study.
  • Involved proxies of deceased older individuals from a representative Dutch cohort and a cohort with ADEs.
  • Utilized cohort data combined with after-death proxy information; logistic regression analyzed determinants of euthanasia requests.

Main Results:

  • 87% of individuals with an ADE maintained a stable desire for euthanasia in the months preceding death.
  • 47% of those with an ADE eventually requested euthanasia, compared to 6% without an ADE.
  • Worry about loss of dignity was associated with a higher likelihood of requesting euthanasia.

Conclusions:

  • The majority of older adults with an ADE maintain stable preferences for euthanasia.
  • An advance desire for euthanasia does not invariably lead to a request; it may serve as a source of reassurance.
  • Concerns regarding dignity are a significant factor influencing euthanasia requests in this demographic.