While physicians may seek to address questions about do-not-resuscitate orders, breathing tubes and emergency contacts, patients want to know how much time they have left, whether they can decide on the setting for their final days and whether their symptoms will ever go away, writes Dr. Ravi Parikh, a Brigham and Women's Hospital resident in primary care and internal medicine. "End-of-life discussions are opportunities to learn more, to start a conversation that we as doctors have been missing out on for quite a while," Parikh writes.
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Older adults experience a sharp increase in the number of life-restricting symptoms in the months before hospice entry, followed by a decline in the number of those symptoms after hospice enrollment and before death, according to a study in the American Journal of Medicine. The findings were based on data from the Precipitating Events Project, which has followed 754 adults ages 70 and older who were without disability at the time of enrollment.
During a program called Moral Distress Rounds, physicians discussed their stress at providing what they considered to be overly aggressive treatment at the end of life, Nneka Sederstrom, director of the Center for Ethics at MedStar Washington Hospital Center, said at the Lown Institute Conference in Chicago. In turn, unnecessary hospitalizations and testing can be the source for much patient stress, said Dr. Joanne Lynn, director of the Altarum Institute's Center for Elder Care and Advanced Illness.
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Hospices have resources and guidance that can help people supporting their loved ones who want to die at home handle the emotional and logistical aspects of fulfilling that wish. "Among our goals in hospice care, which brings quality of life to end of life for both patient and families, is to understand each individual's goal for the final months and final moments, including place of death," writes Rosemary Baughn of the Visiting Nurse Service of New York's Hospice and Palliative Care Division.
The Arizona-based nonprofit Beads of Courage recognizes children with cancer and other serious conditions by giving them beads for treatment and milestones such as overnight stays, blood draws and surgeries. "He has over 927 beads. There may be even more because every now and then, we run out of the yellow beads, and those are for sleepovers at the hospital, and obviously we have a lot of those," Amber Sciarrotta said of her son Victor, who is being treated for an aggressive brain tumor.
Hong Kong and UK researchers found that an injection of interleukin 33, an immune protein that protects the brain and spinal cord, was associated with improved cognition and memory in mouse models of Alzheimer's disease. Within a week of the injection, the test mice regained function similar to that of control mice, according to the research in the Proceedings of the National Academy of Sciences.
The investigation of hospice fraud will be a priority for the HHS, Inspector General Daniel Levinson said at the Health Care Compliance Association's Compliance Institute. Levinson's office issued a report that indicates cases will be judged on a continuum, with a focus on the potential for harm to patients and federal programs.
Researchers using PET and MRI scans found that older adults who took anticholinergic agents such as those found in nighttime cold medicines had reduced glucose metabolism levels in the brain overall and specifically in the hippocampus, lower brain volume and larger brain ventricles, compared with those who didn't take such drugs. The findings in JAMA Neurology, based on national Alzheimer's research data involving 451 cognitively healthy older adults, suggest a biological basis for cognitive impairment associated with the drugs, researcher Shannon Risacher said.
Only a minority of Americans have advance directives, and more people need to have end-of-life conversations, said Barbara Mancini, a Pennsylvania nurse who was charged and later cleared for giving her dying father his prescribed morphine. "In American society, we have a lot of difficulty talking about the end of life," Mancini said.
This year's symposium will provide information that is vital to the entire cancer care continuum from laboratory research to caring for patients' psychosocial and spiritual needs during cancer treatment and at the end of life. Plan your trip to San Francisco today.
The HMDCB exam is just around the corner. Are you prepared? AAHPM has many different study materials to help you prepare, including the Hospice Medical Director Manual and a 75 question online practice test, HMD Prep. Test your knowledge before the exam window opens, May 19-June 6. Find them at the AAHPM Store.
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