Literature Review

How dementia is being defeated: Incidence among the elderly is falling fastThe Economist; 7/26When Eric Stallard, an actuary and academic, began looking into the incidence of dementia among elderly Americans, he was so stunned by his findings that he held off publishing his first paper on the subject for two and ahalf years while he double-checked his work... Instead of confirming the received wisdom that America faced an intensifying plague of the condition, they showed that the proportion of old people succumbing to it was in fact shrinking fast... Last year he and some colleagues published research in the Journal of the American Medical Association showing that, whereas 40 years ago three in every ten Americans aged 85-89 had dementia, by 2024 just one in ten had it.

An exploration of gratitude on well-being in hospice and palliative care familial caregiversJournal of Palliative Medicine; by Kathryn Levy, Pei C Grant, Hannah Rachiele, Gina Schuster, Jonathan L Rossi, Sheila Conboy, Andrew Gasper, Christopher W Kerr; 7/26Familial caregivers (FCGs) play a critical role in health care by providing unpaid care to loved ones with serious illness. Although caregiving is often associated with emotional and physical burden, increasing attention has been directed toward potential sources of meaning and psychological growth, including gratitude. Higher levels of gratitude were associated with greater flourishing and recognition of positive caregiving experiences and were inversely associated with caregiver strain among FCGs of hospice and palliative care patients. Future longitudinal and intervention-based research is needed to determine whether gratitude-focused approaches can improve resilience, psychological well-being, and relational connection in end-of-life caregiving.

Empowering elderly Chinese Americans: Advance care planning educational workshopGeriatric Nursing; by Mengyao Zhao, Tammy Tyree; 7/26Advance care planning (ACP) is important to ensure an individual's values and preferences are followed at the end-of-life (EOL). However, elderly Chinese Americans have a much lower advance directive (AD) completion rate than the national average. This quality improvement project aimed to improve ACP engagement and AD completion rates among elderly Chinese Americans at a local senior center in Arizona. Three monthly culturally tailored educational workshops were conducted, and ... data analysis showed a significant increase in ACP engagement scores over time ...  Additionally, AD completion rates rose by 220% after the intervention. These findings indicate that culturally tailored educational workshops can effectively improve ACP engagement and AD completion rates in elderly Chinese Americans.

Goal-concordant care for older adults with advanced heart failure: A retrospective cohort studyPalliative Medicine; by Sarah Godfrey, Maryjane Farr; 7/26Older adults with advanced heart failure experience significant morbidity and mortality and face higher complication rates from advanced therapies. Of 212 patients, 91 (42.9%) underwent evaluation for advanced therapies, though few received a heart transplant (16, 7.5%) or left ventricular assist device (32, 15.1%). Most (148, 69.8%) had only one palliative physician visit. One hundred thirty-nine (65.6%) died, often in the hospital (55, 40%) and with life-sustaining therapy in the last 24 h (73, 52.5%). Most (167, 78.8%) received goal-concordant care, with the main reasons for discordance being the desire for advanced therapy (33, 15.6%) and complications post-implantation affecting quality of life (9, 4.2%). Conclusions: Few older adults received advanced therapies, and palliative care was underutilized, with many patients seeing palliative care only once. Most received goal-concordant care, but decisions were often made late, highlighting the need for earlier, longitudinal palliative care for these vulnerable patients.

Reports from Duke University describe recent advances in managed care (the South had the lowest rates of hospice and palliative medicine-certified providers in the Us, 2024): managed care Insurance Newsnet; by Staff; 8/13/26 A new study on Managed Care is now available. According to news reporting originating in Durham, North Carolina, by NewsRx journalists, research stated, “To improve access to care for serious illness, policy makers need evidence on how workforce capacity aligns with the need for palliative care. This study evaluated the palliative care workforce and policy environments at the state level, using a new data source: the 2024 Center to Advance Palliative Care’s comprehensive Serious Illness Scorecard.” Funders for this research include US Department of Veterans Affairs, Duke University, US Department of Veterans Affairs, Durham Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Read the study here.

Medical aid in dying: Bridging ethical guidance and bedside communication in nursing practiceJournal of Hospice & Palliative Nursing; by Jeanna Ford, Phyllis Whitehead; 7/26As MAiD [Medical aid in dying] becomes more integrated into serious illness care, nurses, particularly those in hospice and palliative care, are increasingly the first clinicians to receive patient questions about this option. These inquiries are often embedded in broader concerns related to suffering, loss of autonomy, fear of prolonged dying, and desire for control rather than solely requests for hastened death. The Hospice and Palliative Nurses Association’s recent position statement on medical aid in dying emphasizes compassionate, nonjudgmental care, respect for autonomy, professional integrity, and the ethical obligation of nonabandonment while recognizing the complexities of conscientious objection. This manuscript examines the evolving legal and ethical landscape of MAiD, explores the professional implications for nursing practice, and introduces the EXPLORE (Elicit, Explore, Probe Suffering, Learn Values, Observe Pressures, Review Support, Evaluate Next Steps) communication framework, a practice-based model developed to provide nurses with a structured, evidence-informed approach for responding to patient-initiated MAiD discussions. 

Where hospice fails us: A qualitative study of facilitators and barriers in transitions to hospice according to palliative care cliniciansJournal of Palliative Medicine; by Morgan M Nakatani, Julia G Cohn, Kris W Herring, Thomas W LeBlanc; 7/26Transitions to hospice are challenging for patients, caregivers, and health care teams, yet few studies have examined gaps in care from the perspectives of referring palliative care (PC) clinicians. PC clinicians identify substantial barriers to hospice transitions, underscoring the need to improve access to comprehensive end-of-life care. Clinicians emphasized the value of hospice and the Medicare benefit, while identifying barriers to hospice transitions [including] ... inadequate caregiving support, limited reimbursement, uncertainty around eligibility and prognostication, and differences between for-profit and non-profit hospice agencies. These barriers contributed to inequitable access to hospice and gaps in care.