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September 24, 1997

Clinical Crossroads: An 88-Year-Old Woman Facing the End of Life

Author Affiliations

Genesis Physician Services Inc Washington, DC

JAMA. 1997;278(12):977. doi:10.1001/jama.1997.03550120037019

To the Editor.  —As a practicing geriatrician, I enjoyed reading Dr Lynn's discussion of Mrs J, an 88-year-old woman at the end of life.1 I have under my care a 92-year-old woman with strikingly similar conditions, ie, severe aortic stenosis, coronary artery disease, and congestive heart failure (CHF). But, in contrast to Mrs J, 2 years ago my patient reversed her initial decision to have hospice care and underwent 2 balloon valvuloplasties.It appears that Mrs J 1 year before discussion was ready for more aggressive treatment. Otherwise why would she consent to cardiac catheterization? Open heart surgery was not a good treatment option, as Lynn commented. But what about valvuloplasty? A wide range of invasive treatment options can be successful, even in very elderly patients.2Regardless of decisions regarding invasive procedures or surgery, medical management of CHF should be optimized for the patient discussed by Lynn. Angiotensin-converting enzyme inhibitors are a