Saturday, November 26, 2011

Hospitals and Disability in Elders

Hospitals are dangerous for elders. If you care for a hospitalized elder and can read one article that will "change for the better how you care for them," GeriPal recommends this one (From the JAMA, in which activities of daily living are given the acronym ADLs!):

In older patients, acute medical illness that requires hospitalization is a sentinel event that often precipitates disability. This results in the subsequent inability to live independently and complete basic activities of daily living (ADLs). This hospitalization-associated disability occurs in approximately one-third of patients older than 70 years of age and may be triggered even when the illness that necessitated the hospitalization is successfully treated.

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Hospice on Film

The Idaho Press-Tribune highlights two films about hospice programs, "Serving Life," and "Except for Six." The first is about the hospice program at Angola prison in Louisiana. The second follows a character and his family through the dying process. You can watch the trailer for "Serving Life" here, at the Oprah Winfrey Network, it's producer. More on "Except for Six" can be found here.

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What Do You Know About End of Life, Doctor?

Thaddeus Pope highlights questions 26 and 27 from a recent Regence Foundation poll, "Living Well at the End of Life." Pope keeps a blog about futile care (that you should all read) so the two questions he highlights, below, specifically address removal from curative treatment.

A few other interesting points come out in the poll as well: most patients are ill informed about end of life and palliative care options; patients and their families are more concerned with cost than doctors; and if I'm reading the poll correctly, doctors in Oregon and Washington, states where a state-wide discussion about end of life options has been had -- Death with Dignity laws are in place in both -- agree that quality of life is more important than length of life. Then there's the District of Columbia. 96% of doctors there agreed (compared to 71% nationally, and 85% and 83% in Oregon and Washington respectively).

Another series of questions worth looking at are 29, 30 and 31. Practitioners admit that their education and residencies gave them less exposure to end of life issues than did their practice. Read the entire poll findings here.

26. From your experience, how often do patients and their families reject your recommendation to discontinue curative treatment in favor of palliative care?
66% Regularly / Occasionally
34% Infrequently / Never

27. What reasons have patients and their families given for rejecting your recommendation to discontinue curative treatment in favor of palliative care?
75% Unwillingness to accept that curative treatment was ineffective
74% Disagreement from family members about discontinuing curative treatment
63% Preference for more aggressive curative treatment options
42% Religious hesitations or objections
37% Disagreement with the diagnosis or wanted a second opinion
1% Other

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