Literature Review

The presence of implantable cardioverter defibrillators is rarely addressed during code status changeAmerican Journal of Hospice and Palliative Medicine; by Namratha Seetharam Meda, MBBS, Watipa Makhumalo, MD, Hunter Groninger, MD, Clint Pettit, MD; 6/24Implantable Cardioverter Defibrillators (ICDs) are used to prevent sudden cardiac death, but they may provide unwanted shocks during end-of-life care. We aimed to study the frequency at which Do Not Resuscitate (DNR) discussions address ICD preferences in high-risk patients. ... ICD discussions were rarely documented in our high-risk population, highlighting a potential need for better in-chart visibility of ICDs and for focused education of clinicians who care for these patients at end of life.

Telemedicine and e-Health: May issue Telemedicine and e-Health; Editor-in-Chief Charles R. Doearn, MBA, FATA and Executive Editor Karen Rheuban, MD, FATA; published monthly The leading peer-reviewed journal for cutting-edge telemedicine applications for achieving optimal patient care and outcomes. [Relevant titles include the following. These are included in this current May's print edition, many were previously published "online ahead of print."]

Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional studyInternational Journal of Nursing Studies; by Karen B. Lasater, Matthew D. McHugh, Linda H. Aiken; 6/24During the Covid-19 pandemic, Covid-19 mortality varied depending on the hospital where patients were admitted, but it is unknown what aspects of hospitals were important for mitigating preventable deaths. Patients with Covid-19 admitted to hospitals with adequate numbers of RNs caring for patients, a workforce rich in BSN-qualified RNs, and high-quality nurse work environments (both prior to and during the Covid-19 pandemic) were more likely to survive the hospitalization. Bolstering these hospital nursing resources during ordinary times is necessary to ensure better patient outcomes and emergency-preparedness of hospitals for future public health emergencies.Publisher's Note: Also see related KFF Health News article Chronically Understaffed US Hospitals Saw More Covid Deaths, Data Indicate.

Adapting the Serious Illness Conversation Guide for dementia careAmerican Journal of Hospice and Palliative Care; by Charlotte E Berry, Sophie H Montgomery, Robert Santulli, Amelia Cullinan; 8/24Advance care planning (ACP), a critical component of quality dementia care, is underutilized due to lack of clinician comfort and the challenging nature of ACP in this context. The Serious Illness Conversation Guide (SICG) is a well-validated clinician-facing tool, developed with patient and clinician input, to facilitate ACP. The aim of this project was to adapt the SICG for dementia for the first time to promote high-quality ACP.

Parental history of memory impairment and β-amyloid in cognitively unimpaired older adults JAMA Neurology; by Mabel Seto, PhD; Timothy J. Hohman, PhD; Elizabeth C. Mormino, PhD; Kathryn V. Papp, PhD; Rebecca E. Amariglio, PhD; Dorene M. Rentz, PsyD; Keith A. Johnson, MD; Aaron P. Schultz, PhD; Reisa A. Sperling, MD; Rachel F. Buckley, PhD; Hyun-Sik Yang, MD; 6/17/24 Objective: To characterize maternal vs paternal history of memory impairment in terms of brain Aβ-positron emission tomography (Aβ-PET) and baseline cognition among a large sample of cognitively unimpaired older adults. Conclusions and Relevance  In this study, maternal history (at any age) and paternal history of early-onset memory impairment were associated with Aβ burden among asymptomatic older individuals. Sex-specific parental history may help inform clinicians on likelihood of Aβ burden in offspring and help identify high-risk individuals at the earliest stages of disease for prevention.Editor's Note: We posted a descriptive, less data-oriented article that was about this research on 6/21/24, "Alzheimer’s history on maternal side linked to higher disease risk, study finds"

Understanding adult hospices caring for children in California, 2018-2021Heather A. Davis, PhD1, Meaghann S. Weaver, PhD, MD, MPH2,3,Christy Torkildson, PhD, RN, PHN, FPCN, HEC-C4,5, andLisa C. Lindley, PhD, RN, FPCN, FAAN6AbstractIn areas where there are absences of pediatric hospice care, adult hospices are often asked to provide hospice care for children.Little is known about these adult hospices. The purpose of our study was to describe the characteristics of adult hospices inCalifornia that provided care to children from 2018 to 2021. Using public data from the California Home Health Agencies andHospice Annual Utilization Report, we conducted a longitudinal, retrospective descriptive study to examine the effects ofhospice characteristics on adult hospices which provide care to children. Market, mission, operational, and financial characteristicswere measured via the California utilization data using descriptive statistics. Service area was measured via latitudeand longitude public data. Hospice location maps were generated for year 2018 and year 2021. The 148 hospices in the studyhad distinct organizational profiles, mainly small, with broad service coverage areas, in rural and urban communities withpredominantly nurses visiting children. There was a significant decline (32%) in availability of adult hospices caring for childrenbetween 2018 and 2021, particularly in northern California. Hospice economics, lack of familiarity with Medicaid, and staffcomfortability with caring for children in hospice, were not driving this decline. Our study provides critical insight into thecharacteristics of adult hospices in California providing care for children and has important policy implications.

Narrating final memories from spousal loss: The role of place and quality of deathAmerican Journal of Hospice and Palliative Medicine; by Emily L Mroz, Susan Bluck; 8/24Personal memories of the death of a spouse can guide bereavement adjustment. Place of death and quality of death are end-of-life factors that are likely to influence death experiences and formation of subsequent personal memories. The current study employs narrative content-analysis to examine how place and quality of death relate to affective sequences present in older adults' final memories from the death of their spouse. ... Final memories are carried with the bereaved long after their loss. Positive final memories appear to stem from witnessing a comfortable, medically appropriate death outside of a hospital setting. End-of-life 'that is' between care and aligned with patients' values for place and treatment may be critical for spouses' formation of constructive final memories and bereavement adjustment.Editor's Note: Per Yale press release: Emily Mroz, PhD, postdoctoral fellow in the Yale Department of Internal Medicine’s Section of Geriatrics, recently received the Association for Death Education and Counseling (ADEC) Edie Stark-Shirley Scott Early Achievement Award. The honor is presented annually to a woman in the initial years of a career in thanatology—the study of death, dying, and bereavement—who has distinguished herself through activity in scholarship, service, research, clinical practice, or social action.

US Medicare Hospice and Palliative Medicine Physician Workforce and Service Delivery in 2008-2020Journal of Pain and Symptom Management; by Xin Hu, Changchuan Jiang, Qinjin Fan, Kewei Sylvia Shi, Ravi B Parikh, Arif H Kamal, Roger T Anderson, K Robin Yabroff, Xuesong Han; 6/24Despite growth in Medicare HPM physician workforce, access is disproportionately concentrated in metropolitan and inpatient settings. This may limit receipt of early outpatient specialized palliative care, especially in nonmetropolitan areas.

More COVID-19 patients died in understaffed hospitals, new data showUniversity of Minnesota [reported by KFF Health News]; by Stephanie Soucheray, MA; 6/13/24A new study in the International Journal of Nursing Studies suggests chronically understaffed US hospitals had higher rates of COVID-19 patient deaths early in the pandemic. "Our study found that individuals' likelihood of surviving was related to hospitals' investments in nursing services prior to the pandemic—in terms of hiring sufficient numbers of RNs, employing nurses with bachelor's educational preparation, and sustaining favorable work environments," said Karen Lasater, PhD, RN, the lead author of the study, in a press release from the University of Pennsylvania School of Nursing. The study was based on outcomes seen among 87,000 Medicare enrollees (ages 65 to 99) hospitalized with COVID-19 from April through December 2020 in 237 general acute-care hospitals in New York and Illinois. ... Overall, the average age of patients was 78 years, and 31.5 % died within 30 days of admission, with 23% of those patients dying during the hospitalization.

Spousal caregivers need emotional support before losses, not just after, study findsMcKnight's Long-Term Care News; by Donna Shryer; 6/9/24A recent study suggests that healthcare professionals and policymakers should expand their focus on supporting the emotional well-being of individuals whose spouses have dementia, especially in the years leading up to their partners’ deaths. The clinical investigation, published in the Journal of the American Geriatrics Society, indicates that these caregivers experience heightened levels of psychological distress compared to those whose partners have normal cognitive function. ... After the partner’s death, the levels of loneliness and depression were similar across all groups, regardless of the deceased partner’s cognitive status. This suggests that the period before the loss is particularly challenging for those caring for a spouse with dementia. Furthermore, about two-thirds (64%) of these spouses reported lower life satisfaction compared to nearly three-quarters (74%) of those with cognitively healthy partners. However, the study found no significant difference in social isolation levels among the groups.

Geriatric conditions and healthcare utilization among older adults living in subsidized housingJournal of the Americal Geriatric Society; by Sarah E Kler, L Grisell Diaz-Ramirez, Kira L Ryskina, Sun Young Jeon, Kanan Patel, Thomas K M Cudjoe, Christine S Ritchie, Krista L Harrison, W John Boscardin, Rebecca T Brown; 6/24Older adults living in subsidized housing have higher hazards of hospitalization and nursing facility utilization compared to those in the general community. Housing-based interventions to optimize aging in place and mitigate risk of nursing facility utilization should consider risk factors including functional impairment and dementia.

Loneliness, psychological distress, and the moderating effect of positive aspects of caregiving among cancer caregiversSupportive Care in Cancer; by JoAnn Jabbari, Kyle A Pitzer, Keisha White Makinde, Jacquelyn J Benson, George Demiris, Debra Parker Oliver, Karla T WashingtonThe results of this study shed new light on the relationship between loneliness and symptoms of psychological distress experienced by family caregivers of cancer patients, providing a better understanding of the impact that recognition of positive aspects of caregiving has on the association between loneliness and psychological distress symptoms. Our findings emphasize the importance of targeting family caregiver loneliness in order to reduce psychological distress among family caregivers of cancer patients.

Training Senior Companion Volunteers to identify and report adult abuse, neglect, and exploitationJournal of Applied Gerontology; by Jessica Bibbo, Courtney Reynolds, Farida Kassim; 6/24Elder abuse is a national public health challenge that can have dire consequences for the older adults who experience it in any form. The Senior Companion Program presents a unique opportunity to address this public health challenge. An in-person training for Senior Companion volunteers across Ohio on how to recognize and report elder abuse was developed, implemented, and evaluated prior to the COVID-19 pandemic. ... Training older adult volunteers working with other community-dwelling adults is likely a valuable strategy to educate and protect against elder abuse.Publisher's Note: I wonder if similar training could be incorporated into hospice voluteer, social worker, etc., training?