Literature Review

Signs that cognitive changes are worrisome —and what you can do about it CU Anschutz (Colorado University) Department of Medicine; by Tayler Shaw; 7/26/24 ... As a geriatrician and palliative medicine physician, Hillary Lum, MD, PhD, has spent her career working to better the lives of older adults and their families, often raising awareness about what cognitive decline can look like and when it is concerning. She is currently involved in the Colorado Alzheimer’s Disease and Related Dementias State Plan, a state initiative to improve awareness and actions to address dementia in Colorado, specifically looking at how to build a competent workforce related to Alzheimer’s disease and related dementias.  We recently sat down with Lum ... to talk about what cognitive decline is, symptoms to look out for, and how people can best protect their brain health.  

A blood test accurately diagnosed Alzheimer’s 90% of the time, study finds The New York Times; by Pam Belluck; 7/28/24 The New York Times says researchers “reported that a blood test was significantly more accurate than doctors’ interpretation of cognitive tests and CT scans in signaling” Alzheimer’s disease. The study “found that about 90% of the time the blood test correctly identified whether patients with memory problems had Alzheimer’s,” while “dementia specialists using standard methods that did not include expensive PET scans or invasive spinal taps were accurate 73% of the time” and “primary care doctors using those methods got it right only 61% of the time.” The findings were published in JAMA and presented at the Alzheimer’s Association International Conference.

Loss of a loved one early in life may accelerate aging: StudyThe Hill - Health Care; by Miranda Nazzaro; 7/29/24 The experience of losing a loved one early in life could make a person age faster, according to a new study published Monday in the Journal of the American Medical Association. ... Losing a parent or sibling early in life can often be traumatic, causing mental health or cognitive issues, higher risks of heart disease and earlier mortality, researchers noted, adding repeated losses can increase the likelihood of heart disease, dementia or mortality. ... “Future research should focus on finding ways to reduce disproportionate losses among vulnerable groups. For those who experience loss, providing resources for coping and addressing the trauma is essential.”Editor's Note: Click here for the study, "Familial Loss of a Loved One and Biological Again: NIMHD Social Epigenomics Program." Calling all executive leaders who decide staffing and resources for your hospice's bereavement services: examine the long-term mission of your bereavement services for (1) children and teens, (2) young adults, (3) persons with racial and ethnic disparities. 

The bereavement care crisis in hospice facilities MedCity News; by Cara McCarty Abbott; 7/28/24 Bereavement care is an essential part of the hospice experience, designed to support those coping with loss. Bereavement care is not just a compassionate gesture; it is a critical component of the hospice care continuum. So why is it so underserved in the U.S.? ... Instead of pushing harder on hospice providers to find more ways to deliver comprehensive bereavement care with less, it's key to address the systemic forces hampering their ability to deliver quality care at the scale required and address these challenges. Editor's Note: Additionally, does your hospice still rely on the misnamed, overused "5 Stages of Grief"? These were determined from 1960's persons who were dying, not from bereaved persons who live on--surviving--the death. Extensive fresh, contemporary, hospice-designed grief resources to support bereavement counselors and the persons they serve are provided by Composing Life Out of Loss, a sponsor for our newsletter.

AMA Advocacy issue briefsAmerican Medical Association; 7/24/24 Issue briefs summarize key health policy issues by providing concise and easily digestible content targeting both relevant stakeholders and those who may know little about the topic. Contents: Medicare & Medicaid; Telehealth; Scope of practice; Prior authorization; Reducing physician burnout; Practice management; Overdose and mental health/substance use disorder parity; Access to affordable, high-value care; Health care costs & price transparency; Drug costs & pricing; Hospitals & health systems; State medical liability reform; LGBTQ+ health; The business of medicine; Public health improvement; Essential Tools & Resources.

‘My sibling died and my parents never talked about her again’ The Telegraph; by Steph Clarkson; 7/20/24 Julia Martin has few memories of her sister Karen, but remembers the last time she saw her. “She was five years old. I was seven. We were playing on the swing in the park. Then she went off to the hospital with Mum and Dad for a scheduled operation. “She never came home.” Losing a sibling is tragic enough, but for Julia the death of her sister following an operation to repair a hole in the heart was just the start of years of trauma. “I remember my father telling me Karen had died,” says Julia, ... “But that was it. There were no hugs, no comforting words. “Mum barely came near me. She tucked herself away. I had no other siblings to talk to. I was alone.” Things got worse as Julia’s parents built a wall of silence around their loss: ‘‘I wasn’t taken to see Karen in the hospital, I was kept away from the funeral, so there was no closure,” she says.

Positive aging: Can a broken heart kill you?

Navigating legal and ethical issues: Nurses’ role in accessing and using the Death Master File Daily Nurse; by Maya Payne; 7/22/24 Nurses have a great deal of responsibility when managing sensitive information, including access to the Death Master File (DMF), because they are healthcare professionals entrusted with patient care. This article explores the moral and legal issues that help nurses use the DMF in their practice in a morally responsible manner. ... Explore this detailed resource on DMF guidelines for further insights into responsibly using the Death Master File in healthcare settings. Editor's Note: About 10 years ago, the Social Security Office declared me as "dead." Yes. This affected everything financial and legal in my life. My husband even received standardized condolences from businesses with his name as my key contact. Clean up? A mess. Cause? The best that the Social Security Office could discern was that someone, somewhere entered a clerical mistake. I will never know. The effects of how this Death Master File is used--legally, ethically, and otherwise--cannot be understated.

I though my love for climbing died with my husband. I was wrong. Climbing; by Olivia Jordan Cornelius; 7/18/24 What do you do with someone’s climbing shoes when they die? I hadn’t thought about it. After all, my husband, Cam, was 34 and still should have had many years of climbing ahead of him. ... On the shoe rack, they sat as a reminder of the future I had imagined we’d have. Too intimate to give away and too painful to keep, I wrapped them in newspaper and put them in the garbage outside. Then I came back to our apartment and hid my pair in the hallway cupboard. ... Our once-adventurous life together ended in a stuffy hospice room. ... [Click on the title's link for this powerful story of navigating young widowhood.]

Palliative pharmacotherapy for cardiovascular disease: A scientific statement from the American Heart Association Circulation: Cardiovascular Quality and Outcomes - American Heart Association (AHA) / American Stroke Association (ASA); by Katherine E. Di Palo, PharmD, MBA, MS, FAHA, Shelli Feder, PhD, APRN, ACHPN, FPCN, FAHA, Yleana T. Baggenstos, PharmD, Cyrille K. Cornelio, PharmD, Daniel E. Forman, MD, Parag Goyal, MD, MSc, Min Ji Kwak, MD, MS, DrPH, and Colleen K. McIlvennan, PhD, DNP, FAHA on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; 7/24 ... Compared with other serious illnesses, medication management that incorporates a palliative approach is underused among individuals with cardiovascular disease. This scientific statement describes palliative pharmacotherapy inclusive of cardiovascular drugs and essential palliative medicines that work synergistically to control symptoms and enhance quality of life. We also summarize and clarify available evidence on the utility of guideline-directed and evidence-based medical therapies in individuals with end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and other cardiomyopathies while providing clinical considerations for de-escalating or deprescribing. Shared decision-making and goal-oriented care are emphasized and considered quintessential ... across the spectrum of cardiovascular disease.

Advanced practice providers have an important role in kidney supportive care Healio; by Christine Corbett, DNP, FNP-BC, CNN-NP, FNKF; 7/15/24For more than 2 decades, nephrologists and patients have recognized the key role nephrology advanced practice providers have played in the care of patients with chronic kidney disease. ... With its attention to the psychosocial and spiritual aspects of care in addition to the physical, it is expected that nephrology nurse practitioners would also play a major role in the palliative care for patients with kidney disease. ... As part of the kidney care team, APPs [advanced practice practitionsers] educate patients about kidney failure treatment options, including palliative dialysis and active medical management without dialysis. Also, nurse practitioners have been noted to play a significant role in the palliative care skills of goals-of-care conversations, advance care planning and Portable Orders for Life-Sustaining Treatment (POLST, or similar term depending on the state) completion.

2 Ketamine palliative care projects explore interdisciplinary collaborationHospice News; by Holly Vossel; 6/29/24Two ketamine-assisted therapy projects are examining ways to develop training and collaboration models for utilization among palliative care patient populations. A growing body of research is uncovering the potential benefits of ketamine therapies to help with symptom management. But greater understanding of the drug and its impacts is needed to help palliative care providers and other health professionals guide patient experiences, according to Dr. Michael Fratkin, board president of the Institute for Rural Psychedelic Care. Fratkin is also a palliative care specialist at Humboldt Center for New Growth.

Erin and Travis Jean’s son, Felix, died in infancy from a rare skin disorder. Here’s what they’d like other families to know about losing a child. The Boston Globe; by Kara Baskin; 7/12/24 In March 2022, Erin and Travis Jean’s son, Felix, died at two-and-a-half months old from complications associated with epidermolysis bullosa (EB), a rare genetic skin disorder that causes severe peeling and blisters. He was cared for in the NICU at Mass General Hospital before spending his final days at home. ...