Category Archives: End-of-life issues

“Adapting to the Changes of Old Age” – Time Goes By | What it’s really like to get old

Here’s another column from one of our favorite sources.

plato on age“Being about midway into old age now, it seems to me that changes great and small come barreling down the pike lickety-split – that there are many more arriving at a much faster rate than at previous ages of life.

“I can’t prove that with facts and figures and numbers and charts but it feels about right and I’ve come to believe it is an important job of elderhood to learn to adapt as we are buffeted front and back, up and down, left and right and around again with each new, often unexpected development.

“It’s not easy. As you know, my life was upended three months ago with a cancer diagnosis. I’m still trying to find a way to make the large number of restrictions that control my days now as commonplace as, for example, brushing my teeth has always been.

“It’s frustrating that I’m not there yet. I have other things I’d rather do than try to remember if I took those pills after breakfast or treated my hands with that special lotion.”

Read Ronnie’s column in its entirety here.

plato on aging

“Are doctors recommending hospice too late?” – Futurity.com

pre-hospice

“Despite experiencing symptoms for months before the end of their lives, older adults are spending shorter periods of time in hospice.

“The finding suggests there may be a need for more attention to symptoms and disability for these elderly people—and perhaps earlier hospice admission.

“Researchers looked at information from a study of 562 people, aged 70 and older, who were not disabled when the study began but died over the following 16 years.

“Of these individuals, 244 (43.4 percent) were admitted to hospice during the last year of life. They were slightly older and more likely to have cognitive impairments (problems thinking and making decisions) than older adults who weren’t admitted to hospice.”

Read this article at Futurity.com in its entirety, click here.

“Shedding New Light On Hospice Care: No Need To Wait For The ‘Brink Of Death’” – CaliforniaHealtline

Living With Parkinson's Disease

“A few weeks ago, Kathy Brandt’s 86-year-old mother was hospitalized in Florida after a fall. After rushing to her side, Brandt asked for a consult with a palliative care nurse.

“‘I wanted someone to make sure my mother was on the right medications,’ Brandt said.

“For all her expertise — Brandt advises end-of-life organizations across the country — she was taken aback when the nurse suggested hospice care for her mother, who has advanced chronic obstructive pulmonary disease, kidney disease and a rapid, irregular heartbeat.

“‘I was like — really?’ Brandt remembered saying, struggling with shock.

“It’s a common reaction.”

Read this article at CaliforniaHealthline in its entirety here.

“Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds” – California Healthline

handpillbottle

“Nothing seemed to help the patient — and hospice staff didn’t know why.

“They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain.

“The answer came when the woman’s daughter, who was taking care of her at home, showed up in the emergency room with a life-threatening overdose of morphine and oxycodone. It turned out she was high on her mother’s medications, stolen from the hospice-issued stash.

“Dr. Leslie Blackhall handled that case and two others at the University of Virginia’s palliative care clinic, and uncovered a wider problem: As more people die at home on hospice, some of the powerful, addictive drugs they are prescribed are ending up in the wrong hands.”

Continue reading this article in its entirety at California Healthline.

“‘How Long Have I Got, Doc?’ Why Many Cancer Patients Don’t Have Answers” – California Healthline

cancer-decisions-4Bruce Mead-e, 63, who has advanced lung cancer, stands in the garden at his home in Georgetown, Del. Over four years, he has undergone two major surgeries, multiple rounds of radiation and chemotherapy. (Eileen Blass for Kaiser Health News)

by Liz Szabo

“In the past four years, Bruce Mead-e has undergone two major surgeries, multiple rounds of radiation and chemotherapy to treat his lung cancer.

“Yet in all that time, doctors never told him or his husband whether the cancer was curable — or likely to take Mead-e’s life.

“‘We haven’t asked about cure or how much time I have,’ said Mead-e, 63, of Georgetown, Del., in a May interview. ‘We haven’t asked, and he hasn’t offered. I guess we have our heads in the sand.’

“At a time when expensive new cancer treatments are proliferating rapidly, patients such as Mead-e have more therapy choices than ever before. Yet patients like him are largely kept in the dark because their doctors either can’t or won’t communicate clearly. Many patients compound the problem by avoiding news they don’t want to hear.”

Read this article in its entirety at California Healthline.

“Views and Experiences with End-of-Life Medical Care in Japan, Italy, the United States, and Brazil: A Cross-Country Survey” – Kaiser Family Foundation

“In 2014, Americans ages 65 and older made up 15 percent of the total U.S. population; by 2060, that share is projected to grow to 24 percent. A majority of Americans (57 percent) believe the growing number of older people in the U.S. is a problem for the country, including a third (36 percent) who see it as a major problem. Older Americans themselves are more likely to see the aging of the population as a problem; six in ten (62 percent) of those ages 65 and over see it as a problem, including half (48 percent) who believe it is a major problem.”

end of life conversations

“In partnership with The Economist, the Kaiser Family Foundation conducted a cross-country survey of adults in the United States, Italy, Japan, and Brazil about people’s views and experiences related to aging and end-of-life medical care. These four countries are each at different stages of population aging, and have different cultural and institutional considerations when it comes to preparing and providing care for those near the end of life.

“This report gives an overview of the survey results for the U.S. A summary report comparing themes across the four countries and highlighting specific findings in Japan, Italy, and Brazil is available here.

“Using Our Pink Friend (POLST) Appropriately: Please Help!” – GeriPal

NOTE: This article is about the Physician’s Order for Life Sustaining Treatment Form – commonly referred to as the P.O.L.S.T. form. In Pennyslvania, the same form is modified a bit to the Pennsylvania Order for Life Sustaining Treatment.

PAs POLST

POLST Paradigm Forms are different in each state — the order of the sections or the options within a section may be different — but they cover the same information.”

“The National POLST Paradigm Task Force (NPPTF) has just released their updated ‘Appropriate POLST Paradigm Form Use Policy,’ which can be accessed at http://bit.ly/2pJuRmt. So I’ll just start by disclosing that I am very fond of POLST (Physician Orders For Life Saving Treatment).”

Now on to the article at GeriPal: “Using Our Pink Friend (POLST) Appropriately: Please Help!”

 

“35 Years Of American Death | Mortality rates for leading causes of death in every U.S. county from 1980 to 2014.” – FiveThirtyEight

deaths mapMortality rates are age adjusted to account for higher mortality in older populations and geographic variations in the ages of county populations.

“Researchers have long argued that where we live can help predict how we die. But how much our location affects our health is harder to say, because death certificates, the primary source for mortality data, are not always complete. They frequently contain what public health experts call ‘garbage codes’: vague or generic causes of death that are listed when the specific cause is unknown. Garbage codes make it difficult to track the toll of a disease over time or to look for geographical patterns in how people die. The data shown in the map above represents one research group’s effort to fill in these gaps.

Continue reading this article at FiveThirtyEight.com.

“Quality & Safety Consideration for Patients with a POLST or Living Will | Do We Ask for Permission to Treat First? Or Treat first & Ask Questions Later?” – GeriPal

RSS cardThis resuscitation card links to a video by the patient explaining their care preferences:https://vimeo.com/user44599014/review/188926708/25b475b740 The password is: 911.

“As we are educated on the ethical & financial concerns surrounding end-of-life care, we are informed by Institute of Medicine that end-of-life care is broken and accounts for $170 billion in annual spending (1). This projection will exceed $350 billion in less than 5 years. To better align patient wishes, living wills & POLST (Physicians Orders for Life-Sustaining Treatment) are necessary documents and processes. Whether you like them or not they are here to stay are we need to assure provider competency.  Additionally, Medicare now reimburses for advance care planning conversations in the office or via telemedicine. In the past, physicians have tried to embrace living wills and more recently, the POLST paradigm has emerged to the national forefront. POLST & POLST-like processes have grown rapidly, which has outpaced the ability of states to educate to ensure the safe & effective utilization of this process.”

Read this GeriPal article in its entirety, click here.

“Code Blue” – GeriPal

Code Blue

by Marcia Glass, MD

“I sometimes notice ‘DNR’ on my intern’s to-do list during rounds. It usually means his resident asked why this patient, in spite of being so debilitated from his end-stage cancer, or his dementia, or his heart failure, was still full code.  The patient should be made DNR instead, but doing so involves a difficult conversation with sick patients or desperate relatives, sometimes over hours, sometimes over days. Hence, the DNR on the to-do list and the knowing looks from my team. ‘How’s the family?’ ‘Do they get it?’ ‘Are they reasonable?’ Any possibility of a peaceful death depends on my medical team’s ability to make people we hardly know trust us and then change their minds.

“Mrs. J. was different. In her eighties, she came to our hospital … ”

Continue reading this article at GeriPal, click here.