Literature Review

Social determinants of health and US health care expenditures by insurerJAMA Network Open; Giridhar Mohan, MPH; Darrell J. Gaskin, PhD, MS; 10/24US health expenditures have been growing at an unsustainable rate, while health inequities and poor outcomes persist. In this cross-sectional study of 14,918 insured adults, individual-level SDOH [social determinants of health] were significantly associated with US health care expenditures by Medicare, Medicaid, and private insurers. These findings may inform health insurers and policymakers to incorporate SDOH in their decision-making practices to identify and control health care expenditures, advancing health equity.

Most heart failure patients miss out on guideline-recommended palliative care Cardiovascular Business; by Dave Fornell; 11/6/24 Over the past decade, the American Heart Association (AHA) and European Society of Cardiology have recommended integrating palliative care into heart failure management. Despite these recommendations, the use of palliative care for heart failure remains low in the United States. Racial and geographic variations in access and use of palliative care are also pronounced, highlighting health disparities. These were the findings of a recent study in the Journal of the American Heart Association. Researchers at Saint Louis University led the study and said only one in eight patients with heart failure in the United States receive palliative care consultations within five years of diagnosis. Their study highlights the alarmingly low uptake of palliative care among adults with heart failure in the U.S., especially compared to patients with cancers that have the same mortality rates. The study also pointed out significant racial and geographic disparities. Black patients were 15% less likely to receive palliative care compared to their white counterparts. They said this disparity is particularly concerning given the higher cardiovascular risk and mortality rates in the Black population.

Clinician staffing and quality of care in US health centersJAMA Network Open; Q. Wilton Sun, BA; Howard P. Forman, MD, MBA; Logan Stern, DNP, APRN; Benjamin J. Oldfield, MD, MHS; 10/24In this cross-sectional study of 791 US health centers, 5 distinct clinician staffing ratio models were identified, and models emphasizing physicians, advanced practice registered nurses, and physician associates were positively associated with distinct sets of individual quality metrics. In this cross-sectional study of health centers, physician FTE [full time equivalent] ratio was associated with higher performance in cancer screening, infant vaccinations, and HIV testing; APRN FTE ratio was associated with higher performance in preventative health assessments; and PA FTE ratio was associated with higher performance in infant vaccination.

Older Americans living alone often rely on neighbors or others willing to help California Healthline; by Judith Graham; 11/12/24Donald Hammen, 80, and his longtime next-door neighbor in south Minneapolis, Julie McMahon, have an understanding. Every morning, she checks to see whether he’s raised the blinds in his dining room window. If not, she’ll call Hammen or let herself into his house to see what’s going on. Should McMahon find Hammen in a bad way, she plans to contact his sister-in-law, who lives in a suburb of Des Moines. That’s his closest relative. Hammen never married or had children, and his younger brother died in 2022. Although Hammen lives alone, a web of relationships binds him to his city and his community — neighbors, friends, former co-workers, fellow volunteers with an advocacy group for seniors, and fellow members of a group of solo agers. ... American society rests on an assumption that families take care of their own. But 15 million Americans 50 and older didn’t have any close family — spouses, partners, or children — in 2015, the latest year for which reliable estimates are available. Most lived alone. By 2060, that number is expected to swell to 21 million. ... [Click on the title's link to continue reading.]Editor's note: This important article references (1) "a noteworthy study published by researchers at Emory University" titled "Solo but not alone," which we will include in a Saturday research issue and (2) an AAPR survey that gives the name "solo agers." I give a shout-out to the visionary "Living Alone Program" back in 1993 at Hospice of Louisville (now Hosparus), and to all hospices who deliver creative, quality care to persons who live alone.

Do you remember a time when you chose the harder path because it was the right thing to do. It wasn’t easy, but deep-down, you knew it was the right choice. Acting with integrity, even when it’s tough, shapes your character. ~Life Changing Quotes

Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad. ~Henry Wadsworth Longfellow

Comorbid depression in patients with head and neck cancer compared with other cancersJAMA Otolaryngology-Head Neck Surgery; Marina C. Martinez,; Andrey Finegersh, MD, PhD; Fred M. Baik, MD; F. Chris Holsinger, MD; Heather M. Starmer, PhD, CCC-SLP, BCS-S; Lisa A. Orloff, MD; John B. Sunwoo, MD; Davud Sirjani, MD; Vasu Divi, MD; Michelle M. Chen, MD, MHS; 10/24This cohort study found that patients with HNC were twice as likely to screen positive for depression on a validated survey than those with other cancers, despite having similar rates of self-reported depression and depression medication use. These findings suggest that self-reporting of depression may result in underreporting and undertreatment in this population and, thus, a need for further work in developing interventions to improve identification of and optimize treatment for patients with HNC and comorbid depression.

Cancer caregiver anxiety over time: The influence of palliative careJournal of Palliative Care; Laura A Siminoff, PhD; Maureen Wilson-Genderson, PhD; Marcin Chwistek, MD, FAAHPM; Maria D Thomson; 10/24Our analysis detected 3 distinct cancer caregiver groups reporting low, elevated, and very high levels of anxiety. Caregivers with elevated or high anxiety also demonstrated increasing anxiety overtime; however increases were attenuated with patient receipt of palliative care. For cancer caregivers with elevated and high levels of anxiety, palliative care buffers further deterioration of their mental health. Caregivers with the lowest level of anxiety were more likely to be Black, report fewer symptoms of depression or caregiver burden and higher self-rated physical health. Caregivers who were younger reported higher anxiety.

Alzheimer Disease—What’s in a name?JAMA Neurology; Ronald C. Petersen, PhD, MD; Elizabeth Mormino, PhD; Julie A. Schneider, MD, MS; 11/24Back in 2018, the National Institute on Aging (NIA)–AA [Alzheimer Association] group proposed a biological definition of AD [Alzheimer Disease] stating that if a person had the biomarker evidence of brain amyloid (A) and tau (T), the pathologic hallmarks of the disease, the patient had AD irrespective of the person’s clinical state. In their recent 2024 revision, they maintain a biological definition but have extended it to incorporate more recent biomarkers for AD; ... positivity on core 1 biomarkers that indicate the crossing of a specific amyloid threshold on amyloid positron emission tomography (PET), cerebrospinal fluid, and foreseeably, plasma biomarkers. A major question pertains to the requirement for tau in the definition [as] the AA group argues that the vast majority of individuals who have amyloid-positive PET scans have some tau pathology. Furthermore, the AA group proposes a clinical staging scheme that provides a framework to define the frequent mismatch between AD biomarker positivity (and underlying neuropathology) and the clinical expression of the disease, often an indicator of mixed pathologies or resilience. Importantly, although the AA group does base the AD diagnosis on biomarker positivity, they do not currently advise testing in asymptomatic persons in a clinical setting.

[UK] Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: A mixed methods analysisPalliative Medicine; Amy Brown, Sarah Yardley, Ben Bowers, Sally-Anne Francis, Lucy Bemand-Qureshi, Stuart Hellard, Antony Chuter, Andrew Carson-Stevens; 10/24 About 25% of palliative medication incidents involve continuous subcutaneous infusions. Complex structural and human factor issues make these risk-prone interventions. Primary incidents (most proximal to patient outcomes) leading to inappropriate medication use (including not using medication when it was needed) were underpinned by breakdowns in three major medication processes: monitoring and supply ... administration ... and prescribing ... Recurring contributory factors included discontinuity of care within and between settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Psychological harms for patients and families were identified. System infrastructure is needed to enable timely supply of medication and equipment, effective coordinated use of continuous subcutaneous infusions, communication and continuity of care.

Solo but not alone: An examination of social and help networks among community-dwelling older adults without close familyJournal of Applied Gerontology (J Appl Gerontol); by Jane Lowers, Duzhi Zhao, Evan Bollens-Lund, Dio Kavalieratos, Katherine A Ornstein; 11/31/2022... Nearly one in four adults is at high risk for aging without a spouse or children ... Previous descriptions of adults aging solo have focused on social isolation (Chamberlain et al., 2018; Roofeh et al., 2020), yet diverse, non-kin social networks can provide robust emotional and instrumental (task-oriented) support and such networks are becoming more common over time (Suanet & Antonucci, 2016; Verdery et al., 2019), although the type and intensity of support may vary by the type of relationship (e.g., kin vs non-kin) and factors including frequency of interaction (Wellman 1990). ... Therefore, as a first step, we sought to define the population of adults aging solo and compare its social networks and sources of help to adults with close family nearby. Editor's note: Though this article is from 2022, we are posting it due to our post on 11/13/24, Older Americans living alone often rely on neighbors or others willing to help, and our readers' frequent "most read" articles about seniors' challenges with isolation, depression, and caregiving challenges. 

Timing of palliative care, end-of-life quality indicators, and health resource utilizationJAMA Network Open; Sarah J. Mah, MD, MSc; Daniel M. Carter Ramirez, MD, PhD; Kara Schnarr, MD, PhD; Lua R. Eiriksson, MD, MPH; Anastasia Gayowsky, MSc; Hsien Seow, PhD; 10/24In this cohort study of 8,297 individuals with ovarian cancer decedents, initiating palliative care earlier than 3 months before death was associated with lower rates of death in the hospital, late chemotherapy, intensive care unit admission, and aggressive care at the end-of-life. Implementation strategies for early palliative care initiation are needed to optimize care quality and health resource utilization at the end of life.

Unity Hospice to open East Side Resale Shoppe on November 18th The Chamber, Manitowoc County, De Pere, WI; Press Release; 11/13/24 Unity, Northeast Wisconsin’s pioneering nonprofit healthcare provider, is excited to announce the expansion into a second Resale Shoppe location at 1302 S. Broadway in De Pere. This east side location, scheduled to open 10:00 am Monday, November 18, 2024, will provide a meaningful place for the community to donate or purchase cherished household goods and clothing. This new location will allow even greater convenience for customers and donors located on the east side of De Pere.