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Frail Older Adults and Palliative Care—Reply
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In Reply: Dr Finucane rightly points out that the evidence for megestrol benefit is very limited for older adults with weight loss. Unfortunately, in many cases appetite and weight loss are high-priority concerns of patients or their families. In this situation, it may be helpful for clinicians to explain that the cause of weight loss usually is not starvation or inadequate intake but poorly understood metabolic dysregulation. Clinicians may still feel pressured by patients or families to offer any weight loss antidote available, and megestrol may be appropriate to prescribe under these circumstances. Clinicians would be extrapolating from existing evidence of megestrol benefit in patients with cancer,1 many of whom are older, frail, and receiving palliative care.
We concur with Ms Bower's point about the potential contribution of anemia to weakness, slowed performance, fatigue, and low physical activity in older adults. An attempt to correct anemia may improve symptoms, although . . . [Full Text of this Article]
Kenneth Boockvar, MD, MS
kenneth.boockvar@mssm.edu
James J. Peters VA Medical Center
Bronx, NY
Diane Meier, MD
Mount Sinai School of Medicine
New York, NY
RELATED LETTERS
Frail Older Adults and Palliative Care
Thomas E. Finucane
JAMA. 2007;297(11):1193-1194.
EXTRACT
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Frail Older Adults and Palliative Care
Carol E. Bower
JAMA. 2007;297(11):1194.
EXTRACT
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Frail Older Adults and Palliative Care
Daniel Cormican and Peggy A. Seidman
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RELATED ARTICLE
Palliative Care for Frail Older Adults: "There Are Things I Can't Do Anymore That I Wish I Could . . . "
Kenneth S. Boockvar and Diane E. Meier
JAMA. 2006;296(18):2245-2253.
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