LINICALLY SIGNIFICANT DEPRESsion affects 15% to 20% of elderly individuals in the United States. 1,2 Older individuals are less likely than younger adults to have major depression 3 but have comparable or higher rates of less severe depressive disorders such as dysthymia and minor depression. Dysthymia is a chronic depressive syndrome persisting for at least 2 years. 4 According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Appendix of Criteria Sets and Axes Provided for Further Study, minor depression is depressed mood and/or significant loss of interest, plus 1 to 3 other depressive symptoms present nearly every day for at least 2 weeks, occurring in the absence of dysthymia. 4(pp719-721) Minor depression and dysthymia both lead to significant disability. 5,6 Accumulating evidence from primary care set-
In the United States, COPD is the leading cause of respiratory-related deaths and is the third overall leading cause of death. 1 COPD often causes a progressive decline in quality of life and places patients at risk for acute respiratory failure that can require intensive care. Currently, there is no consensus on when discussions about preferences for end-oflife care should take place with these patients. The American Thoracic Society/European Respiratory Society guidelines on COPD recommend these discussions occur for patients with advanced disease while they are clinically stable. 2 Studies show the majority of patients with COPD would like to discuss their preferences for end-of-life care with clinicians, yet less than one-third have done so. 3,4 Studies examining patients dying with COPD or lung cancer have shown that patients with COPD receive more resource-intensive care that is consistent with preservation of life, including greater number of ICU days, and less focus on palliation of symptoms than patients
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