This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Aging/ Geriatrics  • Patient-Physician Relationship/ Care  • End-of-life Care/ Palliative Medicine  • Rehabilitation Medicine  • Hematology/ Hematologic Malignancies  • Anemias  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Frail Older Adults and Palliative Care
Thomas E. Finucane
JAMA. 2007;297(11):1193-1194.
EXTRACT | FULL TEXT  

Frail Older Adults and Palliative Care
Carol E. Bower
JAMA. 2007;297(11):1194.
EXTRACT | FULL TEXT  

Frail Older Adults and Palliative Care
Daniel Cormican and Peggy A. Seidman
JAMA. 2007;297(11):1194.
EXTRACT | FULL TEXT  

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.
ABSTRACT | FULL TEXT