Literature Review

Why are more older people dying after falls? KFF Health News; by Paula Span; 9/30/25 ... Public health experts have warned of the perils of falls for older people for decades. In 2023, the most recent year of data from the Centers for Disease Control and Prevention, more than 41,000 Americans over 65 died from falls, an opinion article in JAMA Health Forum pointed out last month. More startling than that figure, though, was another statistic: Fall-related mortality among older adults has been climbing sharply. ... [Death] rates from fall injuries among Americans over 65 had more than tripled over the past 30 years. Among those over 85, the cohort at highest risk, death rates from falls jumped to 339 per 100,000 in 2023, from 92 per 100,000 in 1990.  ...

Initiation of pregabalin vs gabapentin and development of heart failureJAMA Network Open; by Elizabeth E. Park, Laura L. Daniel, Alyson L. Dickson, Meghan Corriere, Puran Nepal, Kathi Hall, W. Dale Plummer, William D. Dupont, Katherine T. Murray, C. Michael Stein, Wayne A. Ray, Cecilia P. Chung; 8/25Both pregabalin and gabapentin are common nonopioid medications used to treat chronic pain, which affects up to 30% of patients. Because pregabalin has greater potency than gabapentin in binding to the α2δ subunit of the L-type calcium channel, pregabalin may be associated with an increased risk for heart failure (HF). The findings suggest that pregabalin should be prescribed with caution in older patients with noncancer chronic pain.

Wound care at Sheridan VA gives 95-year-old Veteran a second chance: Veteran removed from hospice care at Sheridan VA after wounds heal VA News; by Jesus Flores; 9/12/25 When 95-year-old Air Force Veteran Roy Clifton arrived at Sheridan VA Medical Center (SVAMC) in March 2025, he thought he didn’t have much time left. “I had a bone infection in both feet and could barely walk,” he said. “Then I had a fall that caused a bleed in my brain. That’s when I decided to call it quits and go to hospice.” ... [Scroll ahead to this hospice's expert wound care.] Although both feet had exposed bones, and the injuries looked and smelled bad, Clifton’s body was healing. ... Clifton’s condition improved so much, he was taken off hospice care. “It made me feel great to survive hospice,” he said, smiling. “They’re all great. The staff took good care of me.”

[Canada] Simplifying palliative symptom management: Elastomeric infusions in hospice and home careBritish Journal of Nursing; by Vincetic Bozidar, Natalie Wm Hertzman, Daphne Broadhurst; 7/25Palliative care patients often require frequent, resource-intensive, intermittent subcutaneous injections or complex infusion pumps for end-of-life symptom management. Our findings suggest that continuous subcutaneous infusions via elastomeric infusion pumps offer a promising and feasible approach to end-of-life symptom management in hospice and home care. Elastomeric infusions may enhance simplicity, acceptability, safety, efficacy, and efficiency of care, compared to traditional routine subcutaneous injections.

Implementation of the Pressure Injury Prevention Care Bundle at a home based hospice program: A quality improvement project The Texas Medical Center (TMC) Library Health Sciences Resource Center; by Adaeze U. Amechi-fannin; 8/11/25 Pressure injuries remain a common and serious problem in hospice care, especially among patients who are immobile or confined to bed. Although effective prevention methods are known, inconsistent use of these methods, limited caregiver training, and poor documentation have continued to prevent success in many hospice settings. These wounds cause pain, increase infection risk, and reduce quality of life, making prevention especially important in end-of-life care. ... This project demonstrates that combining structured training, evidence-based care steps, and attention to individual patient needs can successfully reduce pressure injuries in home hospice environments.

Study reveals how medication side effects can lead to dangerous medication cycles in adults 65+ McKnights Long-Term Care News; by Donna Shryer; 7/31/25 When doctors treat drug side effects as new illnesses, older adults may be prescribed even more medications — a cycle known as a “prescribing cascade.” A new study says this prescribing cycle can increase the risk of harm. A prescribing cascade example cited in the research involves older patients taking calcium channel blockers for blood pressure control, which can cause ankle swelling side effects. Instead of first adjusting the blood pressure drug, some doctors immediately prescribe a diuretic to reduce the swelling — which for some, can create an unnecessary drug pair.

Evaluating the role of palliative care in emergency department opioid use among advanced cancer patientsSupportive Care in Cancer; by Joel Nortey, Shiyun Zhu, Andrew Lynch, Hannah Whitehead, Nirmala Ramalingam, Raymond Liu; 7/25 Patients with advanced cancer often experience severe symptoms that significantly impact their quality of life, leading to frequent emergency department [ED] visits for pain management. These visits not only diminish patient quality of life, but also impose substantial costs on the healthcare system. Our study highlights the significant role that PC can play in reducing ED utilization for pain management needs among advanced cancer patients, improving quality of life and alleviating healthcare burdens.

New curriculum - Enhance your pain management skillsCAPC email; 7/16/25Pain is one of the most common and distressing symptoms for patients living with a serious illness, significantly impacting quality of life. CAPC’s new Pain Management: Relieving Suffering and Reducing Risk unit combines our previous two pain units into one streamlined, comprehensive training, incorporating the latest best practices in evidence-based pain management.

Online dialectical behavioral therapy for emotion dysregulation in people with chronic pain-A randomized clinical trialJAMA Network Open; Nell Norman-Nott, BPsychSc; Nancy E. Briggs, PhD; Negin Hesam-Shariati, PhD; Chelsey R. Wilks, PhD; Jessica Schroeder, PhD; Ashish D. Diwan, MD, PhD; Jina Suh, PhD; Jill M. Newby, PhD; Toby Newton-John, PhD; Yann Quidé, PhD; James H. McAuley, PhD; Sylvia M. Gustin, PhD; 5/25Chronic pain, defined as pain persisting beyond 3 months,1 affects 20% to 30% of the population. Beyond its sensory experience, chronic pain is an intrinsically emotional experience associated with heightened negative emotions, including anger, worry, and low mood, alongside a diminished capacity to regulate emotions. Dysregulated emotions contribute to comorbid psychological disorders; symptoms of anxiety and depression, which are present in 50% to 80% of people with chronic pain; and worsening pain intensity. One emotion regulation–focused intervention being adapted for chronic pain is dialectical behavioral therapy (DBT). In DBT skills training, emotion regulation is improved by encouraging emotion recognition, emotion expression, and reaction evaluation. Results of small in-person trials of DBT for people with chronic pain show promise to improve emotion dysregulation, depression, anxiety, and pain intensity.

A practice model for palliative radiotherapyCureus; Alina Zheng, Alec Zheng, Alan Zheng, Xiaodong Wu, Beatriz Amendola; 5/25Despite well-recognized challenges in implementing palliative radiation therapy (PRT), progress remains slow, and conventional approaches have yielded limited success. A specialized certification track within radiation oncology residency programs is proposed, enabling palliative care physicians to obtain limited PRT licenses under the supervision of fully licensed radiation oncologists. Dedicated PRT facilities-affiliated with comprehensive radiation therapy centers (CRTCs) and integrated into hospice settings-will enhance accessibility by reducing logistical and financial burdens. These facilities will utilize cost-effective infrastructure, including refurbished linear accelerators, modular construction, and remote physics and dosimetry support, ensuring operational costs remain significantly lower than those of conventional radiotherapy centers. Systematic studies with a PRT-oriented mindset should establish PRT-specific treatment recommendations and recommendations, moving away from conventional radiation therapy protocols. While requiring initial investment and regulatory adjustments, it has the potential to improve end-of-life care for terminally ill cancer patients, ensuring greater dignity and comfort while establishing a robust foundation for future reimbursement models.

‘Marathon’ effort to refine end-of-life wound coding runs on McKnights Long-Term Care News; by Kimberly Marselas; 5/28/25 Two key wound care groups are finalizing a proposal for new codes that would help skilled nursing providers avoid newly created diagnoses gaps for end-of-life skin breakdown that could lead to missed reimbursement and potential liability risks. The push comes a year and a half after nursing homes won the right to stop coding wounds that occur as part of dying as pressure injuries, which can hurt their quality ratings. But they also lost any way to code or acknowledge treatment of such skin failure in the Minimum Data Set. ...

CMS releases HOPE Guidance Manual (V. 1.01) and TablesCenters for Medicare and Medicaid Services (CMS); by CMS; 4/22/25On April 22, 2025, CMS released the HOPE Guidance Manual (V. 1.01) and connected tables. Providers can use v1.01 for HOPE planning, as this is considered final before HOPE implementation. Also note that earlier this month, the final HOPE data specs have also been released, helping software developers to finalize their HOPE software for testing in the coming months.

Palliative care and advanced cardiovascular disease in adults: Not just end-of-life care: A scientific statement from the American Heart Association AHAIASA Journals - American Heart Association; by Lucinda J. Graven, PhD, APRN, FAHA, Lisa Kitko, PhD, RN, FAHA, Martha Abshire Saylor, PhD, MSN, BA, RN, Larry Allen, MD, MHS, FAHA, Angela Durante, PhD, RN, Lorraine S. Evangelista, PhD, RN, CNS, WAN, FAHA, Amy Fiedler, MD, James Kirkpatrick, MD, Lakeisha Mixon, MSW, and Rachel Wells, PhD, MSN, BA on behalf of the American Heart Association Complex Cardiovascular Nursing Care Science Committee of the Council on Cardiovascular and Stroke Nursing; and Council on Cardiovascular Surgery and Anesthesia; 4/17/25  ... This scientific statement (1) discusses the application of effective communication, shared decision-making, age-friendly care, and advance care planning in advanced cardiovascular disease palliative care; (2) provides a summary of recent evidence related to palliative care and symptom management, quality of life, spiritual and psychological support, and bereavement support in individuals with advanced cardiovascular disease and their care partners; (3) discusses issues involving diversity, equity, and inclusion in cardiovascular disease palliative care; (4) highlights the ethical and legal concerns surrounding palliative care and implanted cardiac devices; and (5) provides strategies for palliative care engagement in adults with advanced cardiovascular disease for the care team.