Literature Review

America’s longest-serving sheriff enters hospice at age 92 Georgia Sun; by Thom Chandler; 10/17/24 Cullen Talton, Houston County Sheriff for nearly 52 years, has entered hospice care, marking the end of an era in Georgia law enforcement. Talton, 92, is the longest-serving sheriff in the United States, and his health decline was announced at the Georgia Sheriff’s Association’s annual luncheon.

Law Offices of Robert E. Brown, P.C. files lawsuit in high-profile home care attendant neglect case involving alleged violent assault on elderly hospice patient Chicago News; 10/22/24 The Law Offices of Robert E. Brown, a leading legal advocate in home care neglect cases, has filed a lawsuit against three Visiting Nurse Service entities and individual defendant Joy Odunze-Matthew, following the violent assault of Carolyn Albanese, a terminally ill hospice patient under their care. The complaint, filed in the Supreme Court of the State of New York, Richmond County, details the disturbing events surrounding the case of Ms. Carolyn Albanese, who was brutally attacked by her home care attendant, Joy Odunze-Matthew, on multiple occasions with a weapon. The most recent attack, which occurred on September 10, 2024, was captured on video and involved the defendant striking the elderly patient with a weapon, leaving Ms. Albanese who was trapped with this home care attendant, with severe physical injuries and mental anguish. Editor's note: This terribly disturbing incident is different from the story we posted yesterday, Home health care aide charged with manslaughter in death of elderly central Florida man. For related posts in today's issue, see De-Escalating angry people: A critical safety skill in education and healthcare. 

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

Nonprofit endeavors to facilitate food justice Towne Post Network; by Julie Yate; 10/17/24 Bringing Justice Home [in Louisville, KY] is a nonprofit organization committed to alleviating hunger caused by food insecurity for those facing disabilities and chronic or serious illnesses. Now in its fourth year, the completely volunteer-run initiative seeks to facilitate food justice by delivering groceries and household supplies to health-compromised families and individuals who fall below the poverty line. Equally important is the relationship building that occurs as resources are shared and volunteers open their hearts to bringing justice closer to home. ... “Bringing Justice Home is a new kind of neighborhood that goes beyond zip codes, race, disabilities, health labels or status,” says Constance Merritt, who co-founded the organization along with her wife, Maria Accardi. Merritt is a published writer and a licensed social worker with a master’s degree from the University of Louisville. She has worked with older adults in low-income senior housing, patients and families in hospital palliative care, and individuals receiving HIV and AIDS services. 

Perspectives on artificial intelligence–generated responses to patient messagesJAMA Network Open; Jiyeong Kim, PhD, MPH; Michael L. Chen, BA; Shawheen J. Rezaei, MPhil; April S. Liang, MD; Susan M. Seav, MD; Sonia Onyeka, MD; Julie J. Lee, MD, MPH; Shivam C. Vedak, MD, MBA; David Mui, MD, MBA; Rayhan A. Lal, MD; Michael A. Pfeffer, MD; Christopher Sharp, MD; Natalie M. Pageler, MD, MEd; Steven M. Asch, MD, MPH; Eleni Linos, MD, DrPH; 10/24Generative artificial intelligence (AI) has the potential to assist clinicians in responding to patients’ messages. Satisfaction was consistently higher with AI-generated responses than with clinicians overall and by specialty. However, satisfaction was not necessarily concordant with the clinician-determined information quality and empathy. For example, satisfaction was highest with AI responses to cardiology questions while information quality and empathy were highest in endocrinology questions. Interestingly, clinicians’ response length was associated with satisfaction while AI’s response length was not. The findings suggest that the extreme brevity of responses could be a factor that lowers satisfaction in patient-clinician communication in EHR.

"Hospice Care Could Be a Compassionate Choice": ChatGPT Responses to Questions About Decision Making in Advanced CancerJournal of Palliative Medicine; by Meghan McDarby, Emily L Mroz, Jessica Hahne, Charlotte D Malling, Brian D Carpenter, Patricia A Parker; 9/24Objective: To examine the content of ChatGPT responses to a hypothetical patient question about decision making in advanced cancer... ChatGPT responses (N= 96) were coded for mentions of: hospice care, palliative care, financial implications of treatment, second opinions, clinical trials, discussing the decision with loved ones, and discussing the decision with care providers... Responses more frequently mentioned clinical trials for vignettes describing 45-year-old patients compared with 65- and 85-year-old patients. When vignettes mentioned a preexisting recommendation for hospice, responses more frequently mentioned seeking a second opinion and hospice care... ChatGPT responses to questions about advanced cancer decision making can be heterogeneous based on demographic and clinical characteristics. Findings underscore the possible impact of this heterogeneity on treatment decision making in patients with cancer.

Roles of pediatric surgeons in palliative pediatric oncologyPediatric Blood and Cancer; by Hau D Le, Sarah Braungart, Jaime Shalkow-Klincovstein, Nelson Piché; 10/24Pediatric surgeons engaged in oncology will inevitably treat patients receiving palliative care, but their role in this context is poorly described. This article identifies some of the challenges and opportunities of surgical involvement in pediatric oncology palliative care, underscoring how the surgeon's expertise can be exploited to significantly benefit children with cancer. Specific examples of skills (procedural, communication, and coordination) that surgeons can provide to the multidisciplinary palliative care teams are described and the importance of collaboration is highlighted.

Tailoring hospice care to the Veteran populationAmerican Journal of Hospice and Palliative Medicine; by Curtis G Kommer, Autumn Nadolny; 10/24United States Military Veterans are an increasingly elderly population, and more and more veterans are choosing hospice care at the end of life. These veterans, particularly if they served in combat, can bring unique management challenges and opportunities to a hospice team. This review highlights the physical and psychosocial traumas experienced by many veterans, and discusses how these issues can affect their hospice care. Traumatic injury-related issues such as chronic pain, neuropathic pain, insomnia, and chronic headaches can worsen for veterans at the end of life, and the psychological sequelae of these traumatic events such as Post-Traumatic Stress Disorder (PTSD), Chronic Anxiety, Substance Abuse, and increased risk of suicide can also be magnified during this time.

Clinician perspectives on palliative care for older adults with serious mental illnesses: A multisite qualitative studyThe American Journal of Geriatric Psychiatry; by Daniel Shalev, Maureen Ekwebelem, Lilla Brody, Karolina Sadowska, Sanam Bhatia, Dania Alvarez, Catherine Riffin, M Carrington Reid; 9/24Approximately 5.5% of the population live with serious mental illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses... Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. The study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.

Mortality and function after widowhood among older adults with dementia, cancer, or organ failureJAMA Network Open; Rebecca Rodin, MD, MSc; Alexander K. Smith, MD, MS, MPH; Edie Espejo, MPH; Siqi Gan, MPH; W. John Boscardin, PhD; Lauren J. Hunt, PhD, RN; Katherine A. Ornstein, PhD, MPH; R. Sean Morrison, MD; 9/24In this cohort study including 13,824 participants in the Health and Retirement Study, widowhood was associated with functional decline and increased 1-year mortality in functionally impaired older adults with dementia and cancer. The study findings suggest that older adults with functional impairment and cancer or dementia are at risk of adverse outcomes following widowhood, including functional decline and a marked elevation in the risk of death, in the year after widowhood.

Patterns of migration following dementia diagnosisJAMA Network Open; Momotazur Rahman, PhD; Bishnu Bahadur Thapa, PhD; Christopher Santostefano, MPH, RN; Pedro Gozalo, PhD; Ulrike Muench, RN, PhD; Cyrus M. Kosar, PhD; Hyesung Oh, PhD; Elizabeth White, APRN, PhD; Vincent Mor, PhD; 10/24In this cohort study of more than 1 million Medicare fee-for-service beneficiaries, individuals with a diagnosis of dementia were almost twice as likely to migrate to another county or state compared with those with diagnoses of myocardial infarction, chronic obstructive pulmonary disease, or colon cancer. Of the excess migrations resulting from dementia diagnosis, 55% occurred in community settings, and 45% occurred in institutional settings. The marked increase in migration among patients following a dementia diagnosis highlights a distinctive need for policy and support interventions tailored to their unique migration patterns and care requirements.

[UK] Symptom management for people with advanced dementia who are receiving end of life careCurrent Opinion in Supportive and Palliative Care; Maria Drummond , Bridget Johnston; 10/24Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia.