Literature Review

Live discharge of hospice patients with Alzheimer’s Disease and Related Dementias: A systematic reviewAmerican Journal of Hospice and Palliative Medicine, by Stephanie P Wladkowski, Cara L Wallace, Kathryn Coccia, Rebecca C Hyde, Leslie Hinyard, Karla T Washington; 2/24This systematic review summarizes the growing body of evidence on live discharge among hospice patients with Alzheimer's Disease and related dementias (ADRD), a clinical subpopulation that disproportionately experiences this often burdensome care transition.

NJ's 'medical aid-in-dying' law upheld by state Supreme Court Public News Service, by Roz Brown; 2/13/24After a five-year court battle, New Jersey's medical aid-in-dying law has been affirmed by the state's Supreme Court, which rejected an attempt to overturn the statute. Signed by the governor in 2019, the law was soon challenged by a physician based on religious, personal and constitutional grounds. It allows mentally capable, terminally ill adults with six months or less to live to get a prescription they can use to end their lives.

A year after Jimmy Carter entered hospice care, advocates hope his endurance drives awareness ABC News, by Bill Barrow, Associated Press; 2/18/24Since Jimmy Carter entered hospice care at his home in south Georgia one year ago, the former U.S. president has celebrated his 99th birthday, enjoyed tributes to his legacy and lost his wife of 77 years. Rosalynn Carter, who died in November, about six months after the Carter family disclosed her dementia diagnosis, lived only a few days under hospice supervision, with her frail husband at her bedside. Experts on end-of-life care say the Carters’ different paths show the range of an oft-misunderstood service. Those advocates commend the Carter family for demonstrating the realities of aging, dementia and death. They express hope that the attention spurs more Americans to seek out services intended to help patients and families in the latter stages of life.Editor's Note: How are you addressing this length of 1+ year with the patients you serve? Click here for the CMS pdf of the 6-month rule, "Face-to-Face Requirement Affecting Hospice Recertification." 

Sunday NewslettersTop read stories of the last week (in order) is the focus of Sunday newsletters - enjoy!

I think the good and the great are only separated by the willingness to sacrifice. — Kareem Abdul-Jabbar

Predicting end-of-life in a hospital settingJournal of Multidisciplinary Healthcare, by Gezy Weita Giwangkancana, Heni Nur Anina, Hadyana Sukandar; 2/9/24(Indonesia) [Early Warning Score] and decreased consciousness are significant predictors of in-hospital mortality. It is crucial in clinical setting to use multiple indicators to predict death and improve patient care.

Ethics at the end of life in the newborn intensive care unit: Conversations and decisionsSeminars in Fetal and Neonatal Medicine, by Mark R. Mercurio, Lynn Gillam; 6/23The unexpected birth of a critically ill baby raises many ethical questions for neonatologists. Some of these are obviously ethical questions, about whether to attempt resuscitation, and, if the baby is resuscitated and survives, whether to continue life sustaining interventions. Other ethical decisions are more related to what to say rather than what to do. Although less obvious, they are equally as important, and may also have far-reaching ramifications... This may serve as a helpful guide for ethical deliberation, and helpful scripting for parental discussion, in similar cases.

What aspects of quality of life are important from palliative care patients’ perspectives? A framework analysis to inform preference‑based measures for palliative and end‑of-life settingsThe Patient - Patient-Centered Outcomes Research, by Nikki McCaffrey, Julie Ratcliffe, David Currow, Lidia Engel, Claire Hutchinson; 11/23Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.

Drugs, delirium, and ethics at the end of lifeJournal of the American Geriatric Society, by Columba Thomas, MD; Yesne Alici, MD; William Breitbart, MD; Eduardo Bruera, MD; Liz Blackler, MBE, LCSW-R; Daniel P. Sulmasy MD, PhD; 1/24For older persons with delirium at the end of life, treatment involves complextrade-offs and highly value-sensitive decisions. The principles of beneficence,nonmaleficence, respect for autonomy, and justice establish important parametersbut lack the structure necessary to guide clinicians in the optimal management ofthese patients. We propose a set of ethical rules to guide therapeutics—the canonsof therapy—as a toolset to help clinicians deliberate about the competing concernsinvolved in the management of older patients with delirium at the end of life.

Disparities in the geographic distribution of palliative care specialists in 2022Journal of General Internal Medicine, by Julia L Frydman, Karen McKendrick, Yingtong Chen, Jonathan Wun, Nathan E Goldstein, R Sean Morrison, Laura P Gelfman; 2/12/24In 2022, the number of HPM board-certified clinicians was 8,935 (6,448 = physicians (72.2%); 2,487 = NPs (27.8%)), which represents 0.7% of the NP workforce and 0.6% of the physician workforce... Our study highlights the uneven geographic distribution of board-certified HPM clinicians, which depends on state, metropolitan status, and area-level SES. 

When we’re talking about diversity, it’s not a box to check. It is a reality that should be deeply felt and held and valued by all of us. — Ava DuVernay

Exploring whether a diagnosis of severe frailty prompts advance care planning and end of life care conversationsNurs Older People, by Stacey Dodson; 2/21/24Findings: Frailty appeared to be complex, multifaceted and at times difficult to identify. A diagnosis of severe frailty did not necessarily prompt advance care planning and end of life care conversations. Such conversations were more likely to happen if the person had comorbidities, for example cancer. Prognostication appeared to be challenging, partly due to the gradual and uncertain trajectory in frailty and a lack of understanding, on the part of healthcare professionals, of the condition and its effects.

Psychological issues in palliative care: Elissa Kozlov and Des AzizoddinGeriPal podcast, by Alex Smith; 2/22/24Today we talk with two psychologists who are deeply invested in addressing psychological aspects of care for people living with serious illness. Elissa Kozlov, a geropsychologist and director of a new population aging MPH at Rutgers, surveyed AAHPM members, and found that doctors reported major shortcomings in level of comfort and knowledge caring for patients with psychological illness. She conducted a systematic review and meta-analysis of 38 palliative care trials, finding that many excluded people with serious illness, and a lack of impact on psychological outcomes.  Analyzing the Health and Retirement Study, she found 60% of older adults screened positive for depression in the last year of life.