Decisions and care at the end of life

Gordon, Michael S.; Сингер, Петер

doi:10.1016/s0140-6736(95)91215-0

Cited by 21 publications

(8 citation statements)

References 23 publications

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“…The level of function in ADL and IADL not only determines whether a person can live alone, but also influences one's quality of life and wellbeing. Living independently at home raises the level of satisfaction of the individual and is assumed to be less costly than residence in an institution (KohlmanMcGourty, 1988;Campion, 1995;Gordon and Singer, 1995;Christenson, 1996;Patherson and Rosenthal, 1997). Evaluating (efficiently and precisely) the functional level of the population to determine their capability and the safety in which they perform is important.…”

Section: Introductionmentioning

confidence: 99%

Validity of the Kohlman Evaluation of Living Skills (KELS) with Israeli elderly individuals living in the community

Zimnavoda

Weinblatt

Katz

2002

Occupation Therapy Intl

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The Kohlman Evaluation of Living Skills (KELS) was developed to evaluate Activities of Daily Living (ADL) and Instrumental ADL (IADL) in a psychiatric population. Later the KELS was assessed and adapted for a geriatric population. The purpose of this study was to determine the validity of the KELS with elderly individuals living in the community in Israel. The subjects included 92 elderly people living in the community, in protected housing facilities for the elderly, and those living in the community and attending day care. Instruments included the Mini-Mental State Examination (MMSE) to determine cognitive function, the Functional Independent Measure (FIM) to determine performance in ADL, and the Routine Task Inventory (RTI) as a measure of IADL to determine criterion validity. Results showed high correlations between the KELS and the RTI (r = 0.895) and the FIM (r = 0.70). The KELS was also found to be highly sensitive to the differences between all three groups, supporting construct validity. Furthermore, the KELS was found to be more sensitive to these differences than the other instruments used in the study. In conclusion, the results show the KELS to be valid and appropriate for use by occupational therapists with the Israeli elderly population, similar to the US population. The study's small sample size limits the generalizability of the findings. It is recommended that further research be done on the KELS with larger and more diverse elderly populations.

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Section: Introductionmentioning

confidence: 99%

Validity of the Kohlman Evaluation of Living Skills (KELS) with Israeli elderly individuals living in the community

Zimnavoda

Weinblatt

Katz

2002

Occupation Therapy Intl

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“…To the Editor : Physicians' desire to help patients is often caught in the tension between their beneficence and patient autonomy. The commitment to autonomy reflected in many North American legislative initiatives has resulted in the increased use of advance directives or “living wills.” 1–6 Most people have ideas about the medical care they would prefer if afflicted with illnesses that would permanently and seriously compromise their function, and most would, at least, like to choose their surrogate 7,8 …”

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confidence: 99%

“…But, what if the care choices have been indicated by the patient and/or surrogate, and these are in conflict with the physician's beliefs? What is the physician obligated to do? 6,13–17 …”

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confidence: 99%

“…Can the physician rightfully ignore the patient's expressed wishes as directed in a living will? Would the physician ignore the same requests if they were made directly by the patient rather than being contained in a living will? 6,16,17 …”

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confidence: 99%

“…Physicians must guard against arguments of resource allocation taking precedence over respect for life. But we must also protect ourselves and our patients from the unrealistic expectation that in the technological marvels of medicine is the hope of prolonging a life which no longer captures its essence and is a charade of its meaning 6 . Proper use and respect for living wills may help achieve this goal.…”

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confidence: 99%

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