Literature Review

Palliative care for older adults with hip fracture: An explanatory sequential mixed-methods studyJournal of Pain & Symptom Management; by Daniel I Hoffman, Sydney Moore, Amanda J Reich, Christina Sheu, Mengyuan Ruan, Masami Tabata-Kelly, Kate Sciacca, Tamryn F Gray, Daniel Dohan, Charlotta Lindvall, Zara Cooper; 6/26After hip fracture, older adults experience burdensome treatments and high mortality; they may therefore benefit from palliative care (PC). Among 1,433 hip fracture admissions, GOCC [goals of care conversations], hospice discussions, and specialty PC were documented in view on their role in GOCC. Conclusion: Limited standardization, role uncertainty, and cultural factors limited PC documentation and delivery, highlighting opportunities to strengthen PC integration in surgical care.

“Nobody told us”: Inequities in end-of-life dementia careJournal of Pain & Symptom Management; by Krista L. Harrison, Lingsheng Li, Jasmine Santoyo-Olsson, Niousha Moini, Lauren J. Hunt, Rebecca L. Sudore, Alex Smith; 6/26In the United States, one in three older adults dies with or from dementia. Despite increasing hospice enrollment, minoritized racial, ethnic, and LGBTQ communities face persistent inequities in access to timely, high-quality end-of-life care. We recruited bereaved caregivers of decedents with dementia from communities that experience health disparities. Just over half of the participants rated end-of-life care middling-to-bad. Reasons cited for receiving poorer care than others were age (40%), race, ethnicity, or nationality (36%), disability (20%), and weight (8%). End-of-life communication challenges reported by participants were often based in systemic racism and structural oppression, including: problems accessing language-concordant education and clinicians, missed opportunities for anticipatory guidance due to cultural biases or lack of access to healthcare, difficulty finding clinicians skilled in sensitive and tailored communication, inconsistent hospice admission criteria, and understaffed hospices.

Serious illness care exclusion, disclosure, & trust for older gay men & caregivers in the Deep SouthJournal of Pain & Symptom Management; by Korijna Valenti, Margaret Armstrong, Michael Barnett, Stacy Smallwood, Ronit Elk; 5/26Older gay men in the Deep South experience serious illness within healthcare systems shaped by heteronormativity and structural racism. Although disparities in access and disclosure are documented, less is known about how negative or ambiguous healthcare encounters are interpreted in serious illness settings. Using a community-based participatory research approach, we conducted semi-structured interviews with 16 participants (11 patients aged 50 years or older living with serious illness and 5 caregivers) residing in the Deep South. Five themes emerged: discriminatory experiences and bias, clinician communication gaps, exclusion from decision-making, system-level gaps in care quality, and disclosure, trust, and safety. Participants described overt and subtle forms of bias, dismissal of partners in clinical encounters, rushed or unclear communication, and institutional barriers that intensified vulnerability during serious illness. Black participants more frequently identified racialized experiences and contextualized mistrust within histories of systemic racism.

The missing middle in healthcare—and why it matters | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Bridget Sumser and Sonya Dolan; 6/20/26 What happens between a life-changing diagnosis and hospice care?  In Part One of this thought-provoking conversation, Chris Comeaux welcomes Mettle Health co-founder Sonya Dolan and Director of Counseling & Programs Bridget Sumser to explore what they call healthcare’s “missing middle.” ... Together, they unpack how Mettle Health was created to provide a different kind of support: one centered on accompaniment rather than treatment, resilience rather than answers, and human connection rather than healthcare transactions.

Signs it’s time for in-home healthcare: 11 warning signs U.S. News & World Report News; by Barbara Sadick; 5/27/26 

Hospitality exec brings hotel playbook to senior living, hits 97% occupancy Pacific Business News, Hawaii; by Cathy Cruz-George; 5/14/26 Mark Tsuda had three decades of hospitality experience when he joined the opening team of Ilima at Leihano, a luxury senior living community in Kapolei, in 2016. He previously was a regional executive for Aston Hotels & Resorts, ... Ilima at Leihano - which provides independent living, assisted living and memory care - has held an occupancy rate of between 95% and 97% over the past six years, supported by 92 employees who balance hotel-style services with healthcare needs and recreation. ... If a resident is in hospice, they can stay with us. Hospice is outsourced to local providers like Malama Ola and Island Hospice, ...

Proposing a framework to license autonomous clinical AI: as autonomous clinical AI continues to evolve, we need uniform regulatory standards, says LDI Fellow Penn LDI - Leonard Davis Institute of Health Economics; by Alon Bergman, PhD; 5/15/26 Late last month, Utah’s Medical Licensing Board called for the immediate suspension of the state’s pilot program with the AI company Doctronic. The program lets a chatbot evaluate patients and recommend prescription renewals for nearly 200 chronic condition drugs, with the state planning to phase out physician review of each case. The board said that it only learned about the pilot after it had launched. Its warning was blunt: proceeding without proper clinical oversight “potentially places Utah citizens at risk.” ... Utah is one of at least 47 states now considering more than 250 bills governing clinical AI, producing a patchwork of rules on bias audits, payment policy, and patient consent.Editor's Note: See related article by the same author Alon Bergman, AI doctors should be licensed. Here’s a framework to do that: Utah's pilot program with Doctronic shows that federal action is necessary. 

Don’t guess with health: Samaritan helps families identify the best care level for their aging loved one citybiz | New York, Philadelphia, Pittsburgh | Non-Profit; by Samaritan; 5/11/26When a loved one’s health begins to decline, families often face one of the most difficult questions in caregiving: What kind of care do they really need? Is it time for home-based primary care? Would palliative medicine improve quality of life while still seeking treatment? Or is hospice the most appropriate next step? ... With a full continuum of services—from primary care to end-of-life care—Samaritan helps families navigate complex healthcare decisions with compassion, expertise, and clarity. ... Editor's Note: Excellent descriptions for "choosing the right level of care" with simple, clear information and "navigation" services.

Pennant acquires senior living communities in Arizona and Wisconsin US National Times, Eagle, ID; Press Release by Globe Newswire; 5/1/26 The Pennant Group, Inc. (NASDAQ: PNTG), the parent company of the Pennant group of affiliated home health, hospice, home care and senior living companies, announced today that effective May 1st 2026, it has assumed operations of three senior living communities across Arizona and Wisconsin, expanding Pennant’s operations by 194 units. The three operations are all subject to triple net leases. ...

Improving advanced practice clinicians' knowledge and comfort of physician orders for life-sustaining treatment form: A homecare quality improvement initiativeGeriatric Nursing; by Jeanette M Ruiz, Yvonne Y Wu, Kristen R Choi, Emily J Martin, Eden R Brauer; 4/26Many advanced practice clinicians (APCs) lack formal training on how to effectively discuss the Physician Orders for Life-Sustaining Treatment (POLST) with chronically ill older adults, often leading to communication gaps and delayed end-of-life decisions. This quality improvement initiative aimed to improve APCs knowledge and comfort in initiating and documenting POLST discussions with community-dwelling geriatric patients. A one-hour online training, incorporating didactic instruction, role-playing, and debriefing, was delivered for APCs providing home-based care. Surveys conducted before and after the training measured ... improvements ...  in POLST completion documentation ... , POLST discussions documentation ... , POLST upload documentation ... , hospice knowledge ... , palliative care knowledge ... , preparedness to discuss POLST ... , comfort with end of life conflict discussions ... , addressing religious/cultural perspectives ... , and use of structured communication frameworks ...