Literature Review

Restarting medications after deprescribing in adults discharged from hospital to skilled nursingJAMA Network Open; by Thomas J. Reese, Sandra F. Simmons, Eduard E. Vasilevskis, Emily K. Hollingsworth, Matthew S. Shotwell, Amanda S. Mixon; 6/26Question: Among older adults discharged to skilled nursing facilities (SNFs) after hospital-initiated deprescribing, what is the frequency and timing of medication restarts ...?  In this cohort study analyzing data from 2 randomized trials with a total of 598 participants, 15.9% of deprescribed medications were restarted. Higher health literacy and longer intervention exposure were associated with fewer restarts, whereas more prescribers, higher number of baseline medications, and fewer pharmacies were associated with medication restarts; restart during the SNF stay was associated with greater 90-day hospital readmissions. Conclusions: In this cohort study, approximately 1 in 6 deprescribed medications were restarted within 90 days, with nearly half occurring soon after SNF discharge. Patient factors and markers of care fragmentation were associated with restart, suggesting that enhancing transitional care and postdischarge support may improve the durability of hospital-initiated deprescribing.

Nurse practitioner: my patient qualified for hospice. I couldn’t get her there The Examiner News; by Diane Pagan; 7/15/26 ... I’ve been Marie’s primary care nurse practitioner for seventeen months. She was referred to me at the time by her PCP because she could no longer physically manage going into the office. She suffered from dementia and her gait was worsening ... Marie’s daughter chose a hospice agency close to her home. The agency reviewed my referral and notes and accepted Marie into their program. The next step was to send them a Certificate of Terminal Illness (CTI) stating that Marie had a terminal illness with an anticipated life expectancy of 6 months or less. Then the obstacle arose. I couldn’t sign the form. ... The inability of nurse practitioners to sign a CTI does not stem from their lack of education or clinical expertise in determining when a patient is nearing end of life. The restriction is rooted in federal Medicare law, written more than 40 years ago, when the role of nurse practitioners was very different than it is today.

Cardiologists treating increasingly complex patients as America ages Medscape; by Sarah Amandolare; 7/14/26 ... Heart failure (HF) affects 15%-20% of adults over 80, according to the American Heart Association/American College of Cardiology/Heart Failure Society of America Guideline for the Management of Heart Failure. HF with preserved ejection fraction (HFpEF), which becomes more likely after age 80, is related to other common conditions of aging, including hypertension, chronic kidney disease, diabetes, and obesity. “Almost by definition, most people that have HFpEF have multiple comorbidities,” Hummel said. “You have to account for a lot of them when you’re thinking about how to help the patient best.” This population also has higher chances of developing dementia and frailty, which affect 35% of adults age 90 and older and 31% of octogenarians, respectively. Older adults hospitalized for HF also have a high likelihood of polypharmacy; 68% take 10 or more medicines.

Most Americans prefer to die at home, but the US healthcare system often prevents it ArcaMax; by Karen Lutfey Spencer; 7/14/26 Ask people what they want at the end of their lives, and overwhelmingly the answers will revolve around comfort, dignity and time at home with loved ones. Yet the U.S. healthcare system often thwarts these wishes. Most Americans say they want to die at home, but only one-third do. What could be an intentional last chapter may instead become a roller coaster of hospitalizations and decisions made with incomplete information. News headlines reflect the challenges of facing the end of life in crisis mode. ... Unfortunately, these crisis scenarios are happening to millions of families each year.

Advance Care Planning is becoming quality data: why the conversation must be documented clearly ICD10monitor, Inver Grove Heights, MN; by Penny Jefferson, MSN, RN, CCDS, CCDS-O, CCS, CDIP, CRC, CHDA, CRCR, CPHQ, ACPA-C; 7/13/26 Advance care planning has always been personal. It is one of the most human conversations that occurs in healthcare. It asks patients, families, caregivers, and clinicians to talk about goals, values, fears, treatment preferences, and what should happen if the patient is no longer able to speak for themselves. But advance care planning is also becoming something else: quality data. In the FY 2027 IPPS/LTCH PPS proposed rule, the Centers for Medicare & Medicaid Services (CMS) proposes adopting an Advance Care Planning electronic clinical quality measure, or eCQM, beginning with the FY 2030 payment determination. CMS also proposes adopting the same eCQM in alignment with the Medicare Promoting Interoperability Program and adopting an Advance Care Planning eCQM for the PPS-Exempt Cancer Hospital Quality Reporting Program beginning with the FY 2030 program year. Editor's Note: FY 2027 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Proposed Rule — CMS-1849-P

Relationships between advance care planning engagement, patients’ religious practices, and spirituality American Journal of Hospice and Palliative Medicine; by Robyn M. Axel-Adams, MS, MDiv, BCC, HEC-C, Emily Fox Ludden, MDiv, MGS, and Alexia M. Torke, MD; 7/2/26Background: Research has shown that people who consider themselves religious have a lower advance directive (AD) completion rate. However, advance care planning (ACP) includes a broader range of activities that are important in determining medical treatments. ... Conclusions: In contrast to prior findings of lower AD completion in more religious individuals, this study found that higher religiosity and spirituality are associated with higher ACP engagement. These results suggest ACP opportunities offered for religious congregations or spirituality focused communities may be especially successful.

Addressing the emotional and psychologic toll of a cancer diagnosis Cancer Therapy Advisor; by Sabrina Martinez, MS and Jason L. Harris; 7/7/26 Patients with cancer experience distress not only from receiving a jarring diagnosis, but also a treatment regimen that can be difficult and debilitating, additional challenges to relationships that might be fraught already, significant financial stress, and the reality of death. Many also experience thoughts of fear of recurrence, stress, depression, anxiety, self-consciousness, and loneliness. The mental and emotional burden of cancer can be as difficult as enduring the disease itself. We spoke with oncologists and experts in psycho-oncology to get their perspectives on delivering “bad” news, working with loved ones and caregivers, resources for those involved in the patient’s cancer journey, and survivorship issues that should be addressed.

[Canada] Palliative care is a fundamental human right TroyMedia; by Rebecca Vachon; 7/6/26 ... Despite the fact that everyone dies, and despite the fact that something like 180,000 Canadians and their families interact with some form of end-of-life care in a year, I keep confronting the perception that palliative care is a niche issue, not one of broad interest. But this reaction only underscores the poll's findings: namely that many Canadians continue to misunderstnad what palliative care is and isn't. On a more positive note, however, when Canadians do understand it, palliative care is, in fact, identified as a priority issue.

Gerontology student Hope Niedrich speaks to the heart of life, death, and belief University of North Carolina Greenville (UNCG), Greenville, NC; by Janet Imrick; 7/2/26 “How would you like your mom or dad or your grandma or grandpa to be treated?” That question summarizes the ideology of Hope Niedrich, who just defended her capstone project before  the faculty in UNC Greensboro’s [master's] gerontology program. That research, she hopes, will improve care for aging populations, whether they’re in her care or with another professional or family caregiver. “Hopefully, we can all show up and treat these people like we would want the adults in our lives to be treated,” she says. ... For her capstone, she created educational guides for volunteers to bridge cultural and religious differences and ensure end-of-life patients receive the utmost comfort and dignity.

Guardianship and hospice care fail dying patients MedPage Today's KevinMD.com; by Kirsten Engel, MD & Madha Tripathi; 6/3/26 “Mr. L” is alone, lying flat on his back in a slightly inclined bed, eyes squeezed shut, hands raised in the air as immobile fists. He has not spoken in weeks. ... The medical team calls it catatonia, a severe psychiatric syndrome that has rendered him mute, immobile, and medically fragile. The psychiatric care team has recommended comfort measures, and our hospice team is ready to accept him. ... Mr. L cannot access hospice because an overworked stranger appointed by the court has not yet returned the hospital’s calls. This is a guardian, a professional fiduciary who has never met Mr. L, who must sign the papers first. So we wait for the court to hold a hearing to approve the order. And Mr. L, still, silent, and suffering, waits with us.