Case #1: Mr. DeSilva

     Mr. DeSilva is an 68-year-old retired welder. Since his wife died 5 years ago, he lives by himself in a one bedroom apartment. He requires supplemental oxygen 24 hours a day because of emphysema. However, he still enjoys his somewhat limited life, which includes reading, television, e-mailing friends, and going out to eat twice a week at a cafeteria close to his apartment building. His two children and four grandchildren come to visit him once a week. He quit smoking several years ago, has had the influenza and pneumonia vaccinations, and uses the inhalers recommended for his emphysema.

     One of Mr. Sawyer’s primary goals is, quite simply, to stay alive.  His physician has advised him that the preventable conditions most likely to cause his death are a lung infection or an accidental fall.  She advised him to brush his teeth several times a day and have his teeth cleaned every 6 months to reduce the number of pneumonia-causing bacteria in his mouth. She also suggested that he wash his hands after getting his food in the cafeteria or after contact with public surfaces before touching his nose or eyes and to tell his children not to visit when they have a cold or the flu.  Because there is evidence suggesting that medicines that reduce stomach acid may increase the risk of pneumonia in people with chronic lung disease, she gave him a list of those over-the-counter medications to avoid.  In addition to those evidence-based recommendations, Mr. DeSilva’s doctor also reviewed his diet and suggested a daily multivitamin could insure that he is getting the vitamins and minerals needed for his immune system to function optimally.