Literature Review

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.

Dying of heart failure: how do we improve the experience? The Medical Journal of Australia - MJA; by Dominica Zentner, Vithoosharan Sivanathan, Jennifer Philip and Natasha Smallwood; published online 6/17/24 ... Despite the improvements afforded by multiple pharmacological, surgical and interventional developments in heart failure, the goal of therapy remains delayed disease progression for many. Cognisant of this reality, recent heart failure guidelines all highlight the important role of palliative care. ... The MJA recently published an article regarding the imperative of reframing palliative care. ... We suggest that ...

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?

Patterns of national emergency department utilization by fee-for-service Medicare beneficiaries with dementiaJournal of the American Geriatrics Society; by Jason K Bowman, Christine S Ritchie, Kei Ouchi, James A Tulsky, Joan M Teno; 6/24Persons with ADRD frequently use the ED-particularly those with recent hospitalizations, rehab/SNF stays, or home health use-and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal-concordant care.

Key factors for establishing and sustaining a successful palliative radiation oncology program: a survey of the Society for Palliative Radiation Oncology Annals of Palliative Medicine; by Deborah C Marshall, Kavita Dharmarajan, Randy Wei, Yolanda D Tseng, Jessica Schuster, Joshua A Jones, Candice Johnstone, Tracy Balboni, Simon S Lo, Jared R Robbins [Palliative Radiation Oncology Programs] PROPS are not widespread, exist mainly within academic centers, are outpatient, have access to palliative care specialists by referral, and have specialized clinical processes for palliative radiation patients. Lack of committed resources was the single most important perceived barrier for initiating or maintaining a PROP. Best practice guidelines, educational resources, access to palliative care specialists and standardized pathways are most important for those who wish to develop a PROP. These insights can inform discussions and help align resources to develop, grow, and maintain a successful PROP.

Palliative care in the intensive care unit: The standard of care AACN - American Association of Critical-Care Nurses; by Clareen Wiencek, PhD, RN, ACNP, FAAN; 6/7/24Intensive care unit–based palliative care has evolved over the past 30 years due to the efforts of clinicians, researchers, and advocates for patient-centered care. ... This article provides an overview of the current state of intensive care unit–based palliative care, examines how the barriers to such care have shifted, reviews primary and specialist palliative care, addresses the impact of COVID-19, and presents resources to help nurses and intensive care unit teams achieve optimal outcomes. [Access to the full article requires subscription or purchase of the individual article.]

Geriatric End-of-Life Screening Tool prediction of 6-month mortality in older patientsJAMA Open Network; by Adrian D. Haimovich, MD, PhD, Ryan C. Burke, PhD, MPH, Larry A. Nathanson, MD, David Rubins, MD, R. Andrew Taylor, MD, MHS, Erin K. Kross, MD, Kei Ouchi, MD, MPH, Nathan I. Shapiro, MD, MPH, Mara A. Schonberg, MD, MPH; 5/31/24In this prognostic study of 82,371 ED encounters within a tertiary care emergency department, the Geriatric End-of-Life Screening Tool (GEST) performed robustly on external validation, identifying 11.6% of the population as having a 30% or greater mortality risk. Compared with serious illness diagnoses, GEST provided a greater net benefit as a screening tool using decision curve analysis. The findings of this prognostic external validation study highlight the opportunity to use pragmatic, prognostic electronic health record algorithms to identify older adults in the emergency department for end-of-life care interventions.Publisher's Note: See related article posted earlier this week from McKnight's Long-Term Care News, Screening tool predicts older adults’ need for end-of-life care intervention.

The role and professional standards of the Adult-Gerontology Nurse Practitioner in hospice and palliative careJournal of Hospice and Palliative Nursing; by Heather Coats, PhD, APRN-BC, Kelly Henrichs, Kelly DNP, RN, GNP-BC; 6/24The adult/gerontology (gero) nurse practitioner (NP) delivers primary and/or specialty palliative care to persons and their families who live each day with a myriad of serious illnesses. In this role, the adult/gero NP uses their skill set to address the whole person (physical, psychological, social, and spiritual/existential) to improve the quality of life for persons they care for. This article is the fourth in a series of 6 highlighting the different roles of the adult/gero NP and the advanced certified hospice and palliative registered nurse, and how these 2 roles overlap. The purpose of this article was to provide details of education and certification pathways for these NP roles, describe the overlaps in clinical care, and illustrate how the adult/gero NP in palliative and hospice care can contribute to leadership in program development for care of persons and their families who live with serious illness.