Literature Review

New insights into older hearts  The New York Times; by Paula Span; 2/15/25 It turns out that the Isley Brothers, who sang that 1966 Motown hit “This Old Heart of Mine (Is Weak for You),” were onto something when they linked age to an aching and flagging heart. Heart disease, the nation’s leading cause of death and disability, has been diagnosed in about 6 percent of Americans ages 45 to 64, but in more than 18 percent of those over 65, according to the Centers for Disease Control and Prevention. ... [In] recent years, dramatic improvements in treatments for many kinds of cardiovascular conditions have helped reduce both heart attacks and cardiac deaths. ... That can complicate decision-making for heart patients in their 70s and beyond, however. Certain procedures or regimens may not markedly extend the lives of older patients or improve the quality of their remaining years, especially if they have already suffered heart attacks and are contending with other illnesses as well. “We don’t need to open an artery just because there’s an artery to be opened,” said Dr. Alexander, referring to inserting a stent. “We need to think of the whole person.” ...

Americans who’ve become caregivers rose by a third in 10 years The Daily Sentinel, Grand Junction, CO; 2/14/25 A growing numbers of family members now provide care for older adults who live at home or in residential care settings, a new study shows. Their ranks increased 32%, from 18.2 million to 24.1 million, between 2011 and 2022, according to new research in the journal Health Affairs. The number of hours that these folks spent caring for older adults with dementia jumped by nearly 50%, from an average 21.4 hours per week in 2011 to 31 hours in 2022. Exactly what is driving the increase in family or unpaid caregiving is not fully understood, but researchers speculate that it may be due to a rise in the number of people who live with the folks who they assist. For the study, researchers culled data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) in 2011 and 2022.  

Advanced cardiac care boosts symptom management, quality of life Carolina Caring, Newton, NC; by Cassidy Collins; 2/12/25 For those living with advanced heart disease or heart failure diagnoses, access to the right medical care can greatly improve their quality of life. This Heart Month, Carolina Caring is spotlighting the Advanced Cardiac Care Program, which provides treatment and clinical support to help patients with heart failure manage their symptoms from wherever they call home. It is the first program of its kind in North Carolina and one of the first established in the nation. It also recognized as a Certified Care program in Palliative/Hospice Heart Failure from the American Heart Association (AHA). Since this certification, Carolina Caring saw a drop to zero readmissions for primary congestive heart failure Hospice patients by the end of 2024. The benefits of this comprehensive, home-based cardiac care program are best illustrated through individuals such as Shirley, a hospice patient who began her journey with Carolina Caring last spring.

Impact of inpatient palliative care on end-of-life care among patients with early-onset colorectal cancerJournal of Clinical Oncology; Suriya Baskar, Bohae R Lee, Rajiv Midha, Udhayvir Singh Grewal; 1/25Palliative care has proven benefits in elderly patients with advanced cancer; however, the objective benefits of palliative care in younger patients with cancer remain under-studied. We sought to examine the impact of inpatient palliative care consultation on end-of-life (EOL) care among hospitalized patients with early-onset colorectal cancer (EO-CRC). Inpatient palliative care consultation at EOL among patients with EOCRC was associated with lesser use of aggressive interventions and higher rates of DNR code status. We also noted significantly lower costs of hospitalization among patients receiving inpatient palliative care consultation at EOL. These results underscore the importance of integration of inpatient palliative care consultation among patients with EOCRC at EOL. 

How to help caregivers of patients with dementia Physician's Weekly; by Linda Girgis, MD, FAAP; 2/13/25 Dr. Linda Girgis discusses how physicians can assist caregivers of patients with dementia, helping these critical caretakers avoid experiencing burnout. ... As doctors, we all have witnessed caregiver burnout. Often, it was a family member who bore the brunt of the responsibility, one for whom there were no vacation days or sick time available. Whatever specialty we practice, we know patients with dementia can present a significant problem. ... How can we assist caregivers of patients with dementia?

Teleios announces completion of Boomer End-of-Life Care Survey Teleios Collaborative Network (TCN), Hendersonville, NC; by Tina Gentry; 2/12/25 Teleios Collaborative Network (TCN) announced the completion of its survey titled “What Baby Boomers Want in End-of-Life Care.” This survey aimed to gain insights into the healthcare preferences and needs of the Baby Boomer generation as they age, transition into retirement and seek end-of-life care. On February 5th, TCN’s Visioneering Council, which comprises member CEOs, C-Suite staff, and marketing managers, gathered to discuss the survey results and explore the best ways to utilize this information to enhance patient care. Before reviewing TCN’s survey findings, Matthew Wilkinson from NPHI and Bill Keane from Emergence presented results from NPHI’s “Aging and End of Life Care Survey.” Additionally, Dr. Terry Fulmer provided insights from the John A. Hartford Foundation’s survey titled “What Older Adults Want from Health Care.” TCN President and CEO Chris Comeaux said, “Over my career, we have been honored to care for the greatest generation. Now that we are at the dawn of the baby boomers being the majority of those we will be honored to care for as they enter their twilight years. Knowing what they expect, what they care about, what they do not want to worry about, all of this is such important data to ensure hospice over the next 30 years is providing an even greater service to patients and families. That’s what this study was looking to accomplish. It’s a great start in that direction.” 

Bringing children home: Kentucky Children’s Hospital’s approach to pediatric end-of-life care American Hospital Association; 2/8/25 When parents have a child with a serious illness, all they want is for their child to get well. If that no longer becomes a possibility, often all they want is to bring their child home. Most — around 70% — of pediatric deaths related to illness occur in the hospital, but the Kentucky Children’s Health Pediatric Advanced Care Team offers some families the chance to transport their child home using life-sustaining technology. That’s not an easy feat; these patients are medically fragile, and the outcome can be unpredictable. A team made up of hospital administrators, hospice providers, coroner and the transportation team comes up with a plan. The child’s parents complete an informed consent procedure, recognizing that their child may not survive the journey home. The transportation team tries to ensure that the journey is as comfortable as possible, as well as planning what to do if the child’s condition deteriorates on the journey. If that happens, he or she will be supported as they pass without resuscitation efforts.

Palliative care initiated in the Emergency Department-A cluster randomized clinical trialJAMA; Corita R. Grudzen, MD, MSHS; Nina Siman, MA, MSEd; Allison M. Cuthel, MPH; Oluwaseun Adeyemi, MBBS, PhD; Rebecca Liddicoat Yamarik, MD; Keith S. Goldfeld, DrPH, MS, MPA; PRIM-ER Investigators; 1/25Question-What is the effect of a multicomponent intervention to initiate palliative care in the emergency department on hospital admission in older adults with serious, life-limiting illness? In this cluster randomized clinical trial, which was conducted at 29 US emergency departments and included 98,922 initial visits, there was no difference in the rate of hospital admission in older adults with serious, life-limiting illness receiving care before (64.4%) vs after (61.3%) emergency department clinical staff receipt of a multicomponent primary palliative care intervention. Relevance-This multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness.

End-of-life-care option bill in New Hampshire stirs conversation on deathMonadnock Ledger-Transcript, Peterborough, NH; by Sruthi Gopalakrishnan; 2/4/25 At age 75, Rep Bob Lynn says he loves life. But he knows he’s no “spring chicken” and his days are finite. The former chief justice of the state Supreme Court is the prime sponsor of House Bill 254, known as “The New Hampshire End of Life Freedom Act,” which gives terminally ill adults the choice to take control of their final days and end their own life with a dose of lethal medication. ... If the legislation passes, terminally ill individuals aged 18 and over with a prognosis of less than six months to live will be able to receive medications to end their lives on their own terms. It comes with a long list of requirements that two health care providers must verify, including that they have healthy mental capacity, are aware of alternative options and are competent to self-administer the drugs. Opponents warned it could encourage suicide, be misused and send a harmful message that people with disabilities are a burden. ... Michelle Flynn, a retired internal medicine physician from Bedford, said allowing terminally ill patients to end their lives opens the door to death as a treatment option. ... Lisa Beaudoin of Temple, founder of Strategies for Disability Equity, worries it would worsen the discrimination disabled people already face in health care. 

Carolina Caring receives a $975,000 grant from The Duke Endowment Carolina Caring; Press Release; 1/29/25 We are excited to announce that Carolina Caring, through the work of Carolina Caring Foundation, has received a $975,000 grant from The Duke Endowment to fund a palliative care pilot program developed in partnership with CaroNova, a nonprofit health transformation catalyst serving North and South Carolina. Combining strategy and solutions to accelerate the future of an affordable, equitable, and effective system of health for all Carolinians, CaroNova works with partners across the Carolinas to drive reforms. The Endowment grant is one of the highest grant amounts Carolina Caring has received in organizational history. The grant will be distributed over two years:  $375,000 in 2025 and $600,000 in 2026. 

High reliability in action — a closer look at Unit-Based Quality Rounds Mass General Brigham; 1/7/25 ... “We’re creating a new process and I’m so proud of all of you because what you have accomplished so far has been amazing,” Nursing Director Vivian Donahue, RN, said at the opening of the huddle with just over 20 physicians, nurses, advance practice providers (APPs), unit staff and hospital and system senior leaders in attendance, including Thor Sundt, MD, chief of Cardiac Surgery for Mass General Brigham. ... At the unit’s first huddle in October, a conversation about the availability of hospice care generated a new referral process that connects patients receiving end-of-life care and their families to hospice services and ongoing emotional support for those coping with the passing of a loved one. At the Dec. 11 huddle, Donahue reported that the unit had provided this welcome, deeply appreciated additional support to five patients and their families.

Opioid painkillers less available to people of color HealthDay News / Coastal Breeze News, Marco Island, FL; 1/30/25 People of color now have less access to prescription opioid painkillers than white patients, an unintended consequence of efforts to stem America’s opioid epidemic. Communities of color have a 40% to 45% lower distribution of commonly prescribed opioids, compared to majority white communities, researchers reported in a study published Jan. 23 in the journal Pain. This could prevent opioid painkillers from reaching those in true need of them, like cancer patients, researchers said. 

The iatrogenic consequences of medicalising grief: Resetting the research agenda Sociology of Health & Illness: by Sarah Gurley-Green, Lisa Cosgrove, Milutin Kostic, Lauren Koa, and Susan McPherson; published 11/28/25, distributed via Evermore 1/28/25When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, there was a firestorm of controversy about the elimination of the bereavement exclusion. Proponents of this change and of the proposed “complicated grief” designation believed that this change would help clinicians recognise major depression in the context of recent bereavement. Other researchers and clinicians have raised concerns about medicalising grief. In 2022 “prolonged grief disorder” (PGD) was officially included in the DSM-5-TR in the trauma- and stressor-related disorders section. ... As human rights activists have argued, bereavement support is an inalienable human right, one that is centered on the right to health and well-being, for “bereavement health is as intrinsic to our humanity as any other aspect of health and citizenship” (Macaskill 2022). That is why there are increasing calls for investing in bereavement as a public good and for “cultivat[ing] a bereavement-conscious workforce.” (Lichtenthal et al. 2024, e273). As Lichtenthal notes, it is not only clinicians but also institutions and systems that must “shift bereavement care from an afterthought to a public health priority.”Editor's note: "Iatrogenic" refers to unintentional consequences/condition from a medical intervention. In the hospice context, this means bereavement/grief from the hospice death. How many patients do you serve? The CMS Hospice Conditions of Participation identify "bereavement" and/or "grief" 155 times. What priority do you give to bereavement care before, at and after your patients' deaths?